Principle, Prevention Coordinator and Teacher Baseline Survey

Attachment O

Baseline Principal Survey

Form Approved

OMB No. 0920-0783

Exp. Date: 06/30/2011

Public Reporting burden of this collection of information is estimated at 15 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency many 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. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Reports Clearance Officer, 1600 Clifton Road NW, MS D-24, Atlanta, GA 30333; Attn: PRA (0920-0783).

Baseline Principal Survey

Purpose

The Centers for Disease Control and Prevention (CDC) thank you for your willingness to participate in our study of the Safe Dates program. You are taking a leading role in allowing the CDC to gather some important information aimed at making this program more accessible to high school students across the nation.

Your perspective is very important to us.

Because of your unique role in the school, your opinions and impressions are particularly important to us. This is the first of three brief surveys we hope you will complete. This survey is expected to take about 15 minutes to complete. We know your time is precious so we’ve limited our questions to those considered the most important.

We are seeking your first impressions and reactions.

Please provide responses based on what you know or what you think. Feel free to use the ‘don’t know’ option as needed. There are no “right” or “wrong” answers.

We recommend that you work quickly without puzzling or worrying about individual questions. We are aware that some questions may appear to be repetitive but it is necessary to ask a variety of questions to obtain reliable and accurate information about the topics addressed in the questionnaire.

Privacy:

All answers you provide will be kept private. Findings will be summarized in aggregated form to protect the identity of participating individuals and schools. However, we ask that you provide your name so that we can match your answers to this questionnaire with those on the subsequent two questionnaires.

Please complete your survey within 2 business days.

Feedback:

In addition to a variety of incentives that your school is receiving in exchange for participating in this study, your school also will receive an executive summary of findings from the study.

PLEASE TELL US A LITTLE ABOUT YOURSELF

Background Information: Please provide the following information so that we will be able a) to match your answers to this survey with the answers you provide on follow-up surveys and b) provide some general background information about survey participants. As noted on the cover sheet, the information you provide will be kept private.

1. Your name: _______________________	5. Tenure at this school: ______yrs. _____mos.
2. Your job title: ________________________	6. Years working in education: ________ yrs.
3. School name:______________________	7. Your gender: _____male ______ female
4. Time in current job: ______yrs.______ mos.	8. Highest degree earned (check one): _____ Associates _____ Bachelors _____ Masters _______ PhD or EdD

9. On average, how often are you in communication with teachers at this school who teach health, wellness and/or prevention classes?

____ never

____ rarely

____ sometimes

____ often

____ very often

10. How would you rate your level of familiarity with the health/wellness/prevention curriculum being taught at this school?

____ not at all familiar

____ somewhat familiar

____ familiar

____ very familiar

____ extremely familiar

11. Do you directly supervise teachers at this school who teach health, wellness, prevention or related courses?

____ No ___ Yes (If yes, about how many teachers do you directly supervise? ______ teachers)

YOUR SCHOOL’S DECISION TO PARTICIPATE IN THIS STUDY

12.

Which of the following reasons explain why your school agreed to participate in the study? (check all that apply) ____ Our participation was mandated by the district or by a higher level within our educational system ____ We value the opportunity to participate in research ____ We get paid for participating ____ We will have access to study results ____ We hoped to add the Safe Dates curriculum to our health/wellness/prevention programming ____ The Safe Dates curriculum fits with this school's strategic goals ____ Other (please explain) _____________________________________ ____ I don’t know

EXISTING VIOLENCE PREVENTION POLICIES, PROGRAMS, ETC. AT THIS SCHOOL

Instructions: The actual and expected incidence of violence on school campuses varies substantially from school to school. As a result, violence prevention policies, strategies and programs (which are referred to as ‘violence prevention initiatives’ throughout the remainder of this survey) also vary from school to school. Please indicate which of the following violence prevention initiatives are currently in effect at your school?  Please MARK ALL of the initiatives which are currently in effect at your school by placing an “X” on the relevant lines below.

School-wide policies and policy enforcement strategies

_____ school-wide, formal policies related to identifying, dealing with, and minimizing the occurrence of violent behavior

_____ staff training pertaining to implementing school-wide violence prevention and reduction policies

_____ a review board (may involve faculty, students, administrators, etc) that makes judgments on cases of violent behavior

_____ contracts to be signed by students (and parents) agreeing to abide by the school’s violence prevention policies

_____ an ombudsmen (or impartial party) to whom students can confidentially report incidents of violence

_____ monitoring by law enforcement, security officers, or other trained staff

Education/informational approaches

_____ teacher training about the topic of violence prevention

_____ special lectures on the topic of violence prevention

_____ curricula addressing adolescent dating violence

_____ other curriculum addressing adolescent violence more generally (e.g., bullying, conflict resolution, peer mediation, or student court programs)

_____ signs etc. posted in areas visible to students related to dealing with and/or reducing violence

Behaviorally – based and related approaches

_____ systems of rewards or incentives for positive or good student behavior

_____ classroom-management program to manage unruly, unacceptable, or violent behavior

_____ interventions for high-risk students involving behavior modification, counseling, or case management

Other environmental approaches

_____ metal detectors on campus

_____ security cameras

_____ open lockers

_____ random unannounced searches of lockers

_____ use of uniform or strict dress code

_____ clear book bags or clear specifications of banned book bags,

_____ steps to control access to the school (e.g., signs, limiting number of entry doors)

_____ structural changes to make it easier to observe students (lighting, more windows, eliminate entrapment zones)

_____ changes to make the school environment more warm and friendly (efforts to keep school clean, eliminate graffiti, display student work, use bright, happy colors)

Instructions: Using the scale provided below, please indicate the extent to which you agree with each of the following statements in light of what you know about this school and its existing violence prevention policies, programs, strategies, which you indicated above. Enter the number that most closely reflects your response in the space provided next to each phrase. Feel free to enter “0” if you don’t know or “9” if you believe the question does not apply to you or your school

Strongly Disagree	Disagree	Somewhat Disagree	Neither Agree nor Disagree	Somewhat Agree	Agree	Strongly Agree		Don’t Know	Not Applicable
1	2	3	4	5	6	7		0	9

	The existing violence-prevention policies, strategies and programs, etc. at this school are very effective…………………………………………………………………………………………………………	_______
	This school's rules and programs for preventing violence seem to work very well…………………….	_______
	This school does a good job preventing fighting and other forms of violence involving students…….	_______
	This school’s policies, programs, and approaches related to violence prevention are well-suited to our needs……………………………………………………………………………………………………….	_______

Instructions: This school is among a group of schools selected to teach, on a trial basis, a dating-violence prevention curriculum called “Safe Dates” as part of a research study. The Safe Dates curriculum is designed to be taught in the form of nine, 50-minute lessons. Based on what you currently know, please answer the following questions. If you have no idea, feel free to skip an item.

	17.	Which of the following options best describes how the Safe Dates (SD) course is likely to be incorporated into your school's broader health or prevention curriculum? ____ SD will be taught as an independent course in the health or prevention curriculum ____ SD lessons will be an intact module within an existing course in the health/prevention curriculum ____ SD lessons will be interspersed among other lessons in the broader curriculum ____ Other (please explain: ______________________________________________)
	18a.	I estimate that the kick-off date for the 9-lesson, Safe Dates Curriculum at this school will be: ______ month ______ year
	18b.	I estimate that the completion date for the 9-lesson, Safe Dates Curriculum at this school will be: ______month _______ year

Instructions: Using the scale provided below, please indicate the extent to which you agree with each of the following statements. Enter the number that most closely reflects your response in the space provided next to each phrase. Enter “0” if you don’t know or “9” if the question does not apply to you or your school.

Strongly Disagree	Disagree	Somewhat Disagree	Neither Agree nor Disagree	Somewhat Agree	Agree	Strongly Agree		Don’t Know	Not Applicable
1	2	3	4	5	6	7		0	9

	This school is very willing to implement new prevention programs that have been developed by researchers………………………………………………………………………………………………………….	_______
	Offering the Safe Dates curriculum is a very good idea for this school………………………………………	_______
	The Safe Dates curriculum must be implemented in a precise manner in order to be effective…………..	_______
	I have been very supportive of this school's efforts to implement our violence prevention initiatives…….	_______
	The advantages of implementing the Safe Dates curriculum at this school will far outweigh any disadvantages………………………………………………………………………………………………………	_______
	This school can deal with difficulties that might interfere with teaching the Safe Dates curriculum as prescribed………………	_______
	The Safe Dates curriculum addresses a need that is already being addressed by an existing program at this school……………	_______
	Scientific evidence indicates the Safe Dates course is effective in reducing dating violence……………..	_______
	I had some knowledge of the Safe Dates program before this school decided to participate in this research study……………	_______
	Implementing Safe Dates will address an important unmet need of our student body	_______
	The Safe Dates course will contribute to the safety of the students who take it	_______
	This school has the resources necessary to support the ongoing implementation of our violence prevention initiatives………………………..	_______
	This school volunteered to implement the Safe Dates curriculum	_______
	Teachers who will be teaching Safe Dates were actively involved in the school's decision to participate in this study	_______
	Top administrators at this school don't seem to care if we implement the Safe Dates curriculum	_______
	The Safe Dates curriculum will be difficult to implement correctly………………	_______
	Teachers will have the final say about which Safe Dates lessons to cover in their classes	_______
	I am very supportive of this school’s involvement in this research study	_______
	This school has strong rules and programs for preventing violence involving students	_______
	Technical assistance is available to staff responsible for implementing components of our violence prevention initiatives……………….	_______
	Honestly, I really don’t care if we implement the Safe Dates curriculum at this school or not	_______

Instructions: Using the scale provided below, please indicate the extent to which you agree with each of the following statements. Enter the number that most closely reflects your response in the space provided next to each phrase. Enter “0” if you don’t know or “9” if the question does not apply to you or your school.

Strongly Disagree	Disagree	Somewhat Disagree	Neither Agree nor Disagree	Somewhat Agree	Agree	Strongly Agree		Don’t Know	Not Applicable
1	2	3	4	5	6	7		0	9

	Research-based prevention programs typically don’t work well in most school settings…	_____
	School administrators do a good job removing barriers that interfere with the implementation of our violence prevention initiatives	_____
	The school's decision to offer the Safe Dates curriculum is a good decision	_____
	Adaptations can be made in how the Safe Dates course is taught without jeopardizing its effectiveness	_____
	Overall, implementing the Safe Dates curriculum will be advantageous to this school	_____
	If unforeseen scheduling conflicts arise, the Safe Dates curriculum can still be delivered as intended	_____
	The Safe Dates curriculum is very similar to a course we already offer at this school	_____
	There is strong scientific evidence suggesting the Safe Dates course reduces violence between dating partners	_____
	I first heard about the Safe Dates curriculum when our school decided to participate in this research study..	_____
	The administration gets regular progress reports about the implementation of this school's violence prevention initiatives	_____
	Safe Dates will be an important addition to the school's health curriculum……………………………………….	_____
	Dating violence will decrease among students who participate in the Safe Dates program.	_____
	Implementation of the Safe Dates curriculum at this school is mandated by a higher authority……………….	_____
	School administrators rather than teachers made the decision to participate in this study about Safe Dates..	_____
	Top administrators at this school seem committed to including Safe Dates in our health and/or prevention curriculum	_____
	It will be easy to prepare teachers to implement the Safe Dates curriculum as recommended by experts…..	_____
	Teachers will be able to decide whether or not to cover all or only some of the lessons included in the Safe Dates curriculum	_____
	Administrators at this school are very supportive of this school’s involvement in this research study………..	_____
	This school puts a lot of effort into preventing violence of any kind among students	_____
	I strongly support including Safe Dates in this school's health curriculum	_____

Instructions: Using the scale provided below, please indicate the extent to which you agree with each of the following statements. Enter the number that most closely reflects your response in the space provided next to each phrase. Enter “0” if you don’t know or “9” if the question does not apply to you or your school.

Strongly Disagree	Disagree	Somewhat Disagree	Neither Agree nor Disagree	Somewhat Agree	Agree	Strongly Agree		Don’t Know	Not Applicable
1	2	3	4	5	6	7		0	9

	Teachers are encouraged to speak openly about the strengths and weaknesses of our violence prevention initiatives	_______
	Teachers at this school know more than academic researchers about what makes a prevention program effective	_______
	The Safe Dates program is likely to be a valuable addition to this school's health/prevention curriculum……	_______
	Some components of the Safe Dates curriculum have to be implemented as prescribed but others do not…	_______
	Implementing the Safe Dates curriculum will have more benefits than drawbacks for this school.	_______
	We are prepared to see that the Safe Dates curriculum is delivered as intended regardless of the obstacles that might arise	_______
	The Safe Dates curriculum will enhance this school's existing health and prevention programming	_______
	There is convincing scientific evidence that shows that Safe Dates reduces dating violence	_______
	This school is highly motivated to implement the Safe Dates program	_______
	Top administrators at this school provide encouragement to staff involved in implementing our violence prevention initiatives	_______
	The Safe Dates curriculum will provide students with knowledge and strategies to reduce the incidence of dating violence in the future	_______
	Teachers who will be teaching the Safe Dates course are doing so voluntarily	_______
	Teachers who will be teaching the Safe Dates course helped decide whether to participate in this study	_______
	Top administrators at this school are committed to ensuring that Safe Dates is part of the health/prevention curriculum	_______
	There are one or more reasons why it will be difficult for teachers to implement the Safe Dates curriculum at this school	_______
	Teachers will be required to teach every lesson included in the Safe Dates curriculum	_______
	Teachers are supportive of this school's involvement in this research study	_______
	Violence of any kind such as fighting, bullying and yelling is not allowed at this school	_______
	The school board has been very supportive of this school's efforts to implement violence prevention initiatives……………………………….	_______
	Teaching Safe Dates exactly as it was developed by experts is critical to getting expected results..	_______

Instructions: Using the scale provided below, please indicate the extent to which you agree with each of the following statements. Enter the number that most closely reflects your response in the space provided next to each phrase. Enter “0” if you don’t know or “9” if the question does not apply to you or your school

Strongly Disagree	Disagree	Somewhat Disagree	Neither Agree nor Disagree	Somewhat Agree	Agree	Strongly Agree		Don’t Know	Not Applicable
1	2	3	4	5	6	7		0	9

	This school can deal with any “bumps in the road” that may arise in the process of delivering the Safe Dates curriculum	_______
	The Safe Dates curriculum will complement existing health and prevention programming at this school.	_______
	Teachers who will be responsible for teaching Safe Dates have chosen to do so	_______
	Teachers who will be teaching Safe Dates were consulted in arriving at the decision to participate in this study	_______
	It will be easy for teachers at this school to implement the Safe Dates curriculum correctly on a consistent basis	_______
	I am committed to seeing that the Safe Dates curriculum is taught at this school	_______
	The Safe Dates course will have long-term benefits for the students who take it	_______
	Students who behave violently are not allowed to stay at this school	_______
	Staff members who are responsible for implementing this school’s violence prevention initiatives have a clear understanding of their roles and responsibilities.	_______