DRUMBEAT FACILITATOR DECLARATION FORM B

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1 DRUMBEAT FACILITATOR DECLARATION FORM B This document provides evidence to Holyoake that you, as a trained DRUMBEAT Facilitator, have proficiently delivered the DRUMBEAT program to a client group within 12 months of completing your training. The first two pages are filled out by the facilitator who delivered the program and a witness signs to confirm the 10 week DRUMBEAT program was delivered. The witness can be anyone, for example: your co-facilitator, Manager, School Principal, or even the person who sat in on one session to assess your facilitation skills. The last two pages are completed by the person who sat in on one session to assess your facilitation skills. They need to tick the boxes and also sign the last page (This part is necessary to gain your accreditation). The Assessor can be either: Manager, Supervisor, Team Leader, School Principal or Vice Principal, School Psychologist, a Senior DRUMBEAT Accredited Facilitator, anyone with clinical experience or extensive group facilitation experience Upon receipt of this document, completed and witnessed as required, Holyoake will issue you with a certificate awarding full DRUMBEAT facilitator status. Please Note: All pages are required to be filled out. Please fax, post or completed form to Holyoake Fax: Within Australia: International: Post: C/- Holyoake Institute, PO Box 322, Victoria Park WA For Holyoake Office Use Only Approved Requires further assessment

2 Name Date of Facilitator training attended Place of Facilitator training attended. Postal Address for Certificate. Suburb/Country/State..Post code.. Occupation/Role Work Phone. Mobile. What region/area do you work in?... Place and address of program delivery (school, youth service, etc). Demographic of client group (gender, age, cultural background, confronting issues, etc). Time period over which the DRUMBEAT program was run: Starting Date.. Finishing Date Number of participants in the group.. Gender Mix... Name of co-facilitator (if present) 1

3 Please rate your impression of general change in your DRUMBEAT group member s behaviour over the period of the program using the following scale 1 10 with 5 representing no change and 1 extremely negative change and 10 extremely positive change Relationship with Peers Relationship with Adults/ Teachers Emotional Control Group Participation Self Esteem Self - confidence Level of focus and concentration OUTCOMES Please give a brief description of the outcome of your program (needs to be filled out) (For example: What worked well; what needs reviewing; how did participants engage; were there any comments from 3 rd party observers - additional pages are welcome as well as photos if you have permission) Name of witness.... Position of witness Contact of witness.... Contact Phone of witness Signature of witness.... Date signed 2

4 DRUMBEAT Group Facilitation Appraisal Instructions for completion of assessment: Assessor needs to sit in on one DRUMBEAT session (you become part of the group and sit within the circle with a drum) The Assessor can be either: Manager, Supervisor, Team Leader, School Principal or Vice Principal, School Psychologist, a Senior DRUMBEAT Accredited Facilitator, anyone with clinical experience or extensive group facilitation experience. If you have any queries about this process, please Name of Facilitator: Venue: Date: Number in Group: Current DRUMBEAT accreditation status Needs Attention (1) Rating (please tick against each item) Satisfactory Good (2) (3) Excellent (4) Opening Process Introduction Energy / warmth Group Process Establishing theme Awareness raising Summarising Bonding Skills Inclusion Building trust Non-judgemental Communication skills Helping Skills Empathy Listening Responding Attending Genuineness Respect Focus on Feelings Identifying feelings Allowing expression of feelings Drumming Skills Competence in core rhythms Teaching skills promoting inclusion Encouraging improvisation Creativity Inventiveness Flexibility 3

5 Needs Attention (1) Rating (please circle against each item) Satisfactory Good (2) (3) Excellent (4) Behaviour Management Skills Tolerance Ability to reduce conflict Boundaries Problem solving Awareness of own values (judgments/biases) Closing Closing process COMMENTS FROM ASSESSOR: Overall assessment of s (insert name of staff member) group facilitation skills Needs Attention Satisfactory Good Excellent Signature of Facilitator Date: Name of Supervisor/Assessor Title of Supervisor/Assessor Signature of Supervisor/Assessor Date: 4

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