ACHA Consultation Services
1
Pre-Assessment Information
Thank you for your interest in ACHAs Peer Review Assistance
Program. Please provide the following information, which will be
used as a guide for selecting your Reviewers and coordinating your
site visit. This information will be shared with the Reviewers
prior to the site visit and in the planning and development of your
Peer Review Assistance Report. Complete this text version and email
it to [email protected] at the ACHA national office.
Name of Institution:Web Address of the Health Center:Name of
Person Requesting the engagement: Title/Position: Postal Address:
City, State, Zip: Phone: Fax: Email: Information for the contact
during onsite visit, if other than above:Institutional Demographics
(check all that apply):
Two year Four year Public Private Urban Suburban Rural Fulltime
Undergraduate Fulltime Graduate/Professional
Campus Size: 0 9,999 students 10,000 19,999 students 20,000
students or more
Describe the key aspects of your institution, (i.e., special
attributes, history, locale, etc.)
Describe the key aspects of your student population.
Describe the key aspects of the health status of the student
population. Please reference any data sources.
Describe the key aspects of the college health program on your
campus. For example, is it primarily focused around
clinical/medical services, are health promotion and prevention
services provided, are counseling services provided, are there
recreation/wellness services, etc.
Describe the campus community and any key resources or
services.
Describe the key public health policies on the campus, (i.e.,
immunizations, smoking, public safety, insurance, etc.)
Describe all the funding sources for your services.
Describe the basic focus of the peer-review. Is there any one
single topic that you would like to address?
Provide details of any specific issues you would like the
peer-review to address, (i.e., leadership, staffing, scope of
services, quality of services, etc.)
List three specific outcomes you would like to derive from the
peer-review.
What resources are you interested in using as references to
improve your services? Please highlight or check all that
apply.
ACHA Resources: ACHA College Health Salary and Staffing Report
ACHA-National College Health Assessment (NCHA) Reference Group
Executive Summaries Campus Response to Novel Influenza H1N1
Considerations for Integration of Counseling and Health Services on
College and University Campuses Cultural Competency Statement Drug
Education and Testing of Student Athletes Emergency Planning
Guidelines for Campus Health Services: An All Hazards Approach
General Statement of Ethical Principles and Guidelines Guidelines
for Hiring Health Promotion Professionals in Higher Education
Healthy Campus: Student, Faculty/Staff Objectives Position
Statement on Preventing Sexual Violence on College and University
Campuses Recommendations for Institutional Prematriculation
Immunizations Standards for Student Health Insurance/Benefits
Program Standards of Practice for Health Promotion in Higher
Education Tuberculosis Screening and Targeted Testing of College
and University Students
Other Relevant Resources: The Council for Advancement of
Standards (CAS) Book of Professional Standards in Higher Education
The Accreditation Associationfor Ambulatory Health Care (AAAHC)
Accreditation Handbook for Ambulatory Health Care The Joint
Commission Comprehensive Accreditation Manual for Ambulatory Care
The American College Personnel Association (ACPA), the Association
of College and University Housing Officers-International (ACUHO-I),
the Association of College Unions International (ACUI), the
National Association for Campus Activities (NACA), the National
ACademic ADvising Assocation (NACADA), the National Association of
Student Personnel Administrators (NASPA), and the National
Intramural-Recreational Sports Association (NIRSA) Learning
Reconsidered 2: A Practical Guide to Implementing Campus-Wide Focus
on the Student Experience
Other Resources:
Of the following topics, please highlight or check all that will
apply to this visit.
Business Plans CAS Professional Standards-Council for the
Advancement of Standards in Higher Education (CAS) Emergency
Planning & Response Facilities Planning, Design, &
Renovation Faculty & Staff Health Services Funding &
Revenue Sources, Third Party Billing Health Center Organization
& Structure Health Education & Health Promotion Services
Health Policy Development Healthy Campus 2020 (and Healthy People
2020) Integration of Counseling and Health Services Medical
Records, Electronic Medical Records Mental Health & Counseling
Services Patient Satisfaction Peer Education & Student
Involvement Pharmacy Operations & Services Prevention
Programming Public Health & Safety Quality Improvement
Self-Funded Student Health Plans Staffing-Productivity &
Efficiency Staffing-Salaries/Compensation Standards of Practice for
Health Promotion in Higher Education Strategic Planning Student
Health Advisory Committees (SHACs) Student Health Assessments
Student Health Insurance, Patient Protection and Affordable Care
Act (PPACA) Student Learning Outcomes Teambuilding Utilization
Review Other topics:
What background would you prefer the Reviewers to have? (i.e.,
student affairs administration, clinical, health education,
nursing, business administration, public health, psychology,
leadership expertise, others)
What campus settings would you prefer the Reviewers to be
familiar with? (i.e., small, medium, large enrollment; private or
public; urban or rural; state system; faith-based; community
college, others)
Please provide any other information that is relevant to this
request.
Please list five sets of two-day dates, in priority order, that
would be the best time for the site visit. Allow a minimum of two
months lead-time after the receipt of this form.
How did you hear about the Peer Review Program?
Email this completed form to:ACHA National OfficeEmail:
[email protected]
Questions? Telephone: (410) 859-1500, ext. 234
