Principle and Prevention Coordinator Mid-Implementation Survey

Attachment S

Mid-Implementation Prevention Coordinator 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).

Mid-Implementation Prevention Coordinator 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 second of four brief surveys you are being asked to complete. We estimate that it will take about 15 minutes to complete this survey. 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.

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 your answers to prior surveys, 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 title: ________________________

PLEASE NOTE: Regardless of your job title, we use the term 'prevention coordinator' when we refer to your job in this survey.

2. Time in current job: ______yrs.______ mos.

Instructions: As you are aware, [SCHOOL NAME] 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. Questions in this survey refer to [SCHOOL NAME]. Based on what you currently know, please answer the following questions. If you have no idea, feel free to skip an item.

3.

Which of the following options best describes how the Safe Dates (SD) course is being incorporated into your school's broader health or prevention curriculum? ____ SD is being taught as an independent course in the health or prevention curriculum ____ SD is being treated as an intact module within an existing course in the health/prevention curriculum ____ SD lessons are being interspersed among other lessons in the broader curriculum ____ Other (please explain: ______________________________________________)

4.

The actual kick-off date for the 9-lesson, Safe Dates Curriculum at this school was: ____ 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

	The resources needed to implement Safe Dates are already part of the school's regular operating budget.	_____
	The decision to offer the Safe Dates curriculum was a very good idea for this school	_____
	Teachers have the final say about which Safe Dates lessons to cover in their classes	_____
	Teachers seem interested in the material included in the Safe Dates curriculum	_____
	The Safe Dates curriculum addresses an important unmet need of our student body	_____
	Top administrators at this school don't really seem to care whether or not we continue to implement the Safe Dates curriculum	_____
	We are implementing the Safe Dates curriculum on a trial basis and only within the context of this research study	_____
	The advantages of implementing the Safe Dates curriculum at this school far outweigh any disadvantages	_____
	Clear and specific goals have been established pertaining to the implementation of the Safe Dates curriculum during the course of the study	_____
	The administration monitors the implementation of the Safe Dates curriculum	_____
	Teachers and staff involved in implementing the Safe Dates curriculum get recognition from their superiors	_____
	School administrators adequately address the concerns of teachers who are implementing the Safe Dates curriculum	_____
	The Safe Dates curriculum must be implemented in a precise manner in order to be effective	_____
	Formal training is needed in order for teachers to do a good job implementing the Safe Dates curriculum	_____
	The Safe Dates curriculum is complicated to implement correctly	_____
	The Safe Dates curriculum has been implemented “to the letter” as prescribed by its developers	_____
	The district office has been very supportive of this school's efforts to implement the Safe Dates curriculum	_____
	It is not clear who is leading this school's efforts to implement the Safe Dates curriculum	_____
	If needed, teachers have access to experts who know how to implement the Safe Dates 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 seem enthusiastic about teaching the Safe Dates curriculum	____
	Safe Dates has been an important addition to this school's health curriculum	____
	Top administrators at this school seem committed to including Safe Dates in our health and/or prevention curriculum	____
	We are planning to implement the Safe Dates curriculum during the next school year	____
	Implementing the Safe Dates curriculum has had more benefits than drawbacks for this school.	____
	Overall, students seem to like the Safe Dates curriculum	____
	Teachers are discouraged from expressing their concerns about the Safe Dates curriculum	____
	Teachers are able to decide whether or not to cover all or only some of the lessons included in the Safe Dates curriculum	____
	Adaptations can be made in how the Safe Dates course is taught without jeopardizing its effectiveness	____
	The Safe Dates curriculum is seen as a permanent part of this school's curriculum	____
	The school's decision to offer the Safe Dates curriculum was a good decision	____
	This school has the resources necessary to support the ongoing implementation of Safe Dates	____
	The curriculum guide is sufficient to prepare the average teacher to do a good job implementing the Safe Dates curriculum	____
	It is easy to prepare teachers to implement the Safe Dates curriculum as recommended by experts.	____
	The Safe Dates curriculum we’re implementing is a modification of the original curriculum	____
	The school board has been very supportive of this school's efforts to implement the Safe Dates curriculum	____
	There was not enough time to adequately plan for the implementation of the Safe Dates curriculum at this school	____
	Training is available to any teacher who needs guidance in order to implement Safe Dates as prescribed by experts	____
	The school administration has clearly communicated its expectations pertaining to the implementation of the Safe Dates curriculum during the course of the study	____
	School administrators insure that everything necessary for the implementation of Safe Dates is available to teachers	____
	The school has the manpower necessary to support the ongoing implementation of Safe Dates	____

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 given positive feedback for contributing to the implementation of the Safe Dates curriculum	_______
	The administration holds meetings with teachers to review how the implementation of Safe Dates is going	_______
	Teachers are encouraged to speak openly about the strengths and weaknesses of the Safe Dates curriculum	_______
	The Safe Dates curriculum is seen as a temporary addition to this school's curriculum	____
	The Safe Dates curriculum is a valuable addition to this school's health/prevention programming	____
	Teachers are required to teach every lesson included in the Safe Dates curriculum	____
	Teachers seem to like the classroom activities included in the Safe Dates curriculum	____
	This school continues to be highly motivated to implement the Safe Dates curriculum	____
	Top administrators at this school are committed to insuring that Safe Dates is a permanent part of the health/prevention curriculum	_______
	The Safe Dates program is likely to be part of our prevention curriculum in the years to come	____
	Overall, implementing the Safe Dates curriculum has been advantageous to the students at this school	_______
	I like the Safe Dates curriculum	____
	Some components of the Safe Dates curriculum have to be implemented as prescribed but others do not	_______
	The average teacher is likely to need follow-up training or coaching in order to do a good job implementing the Safe Dates curriculum	_______
	There are one or more reasons why it is difficult for teachers to implement the Safe Dates curriculum at this school	_______
	The most important elements of the Safe Dates curriculum have been implemented as prescribed by program developers	_______
	Parents have been very supportive of this school's efforts to implement the Safe Dates curriculum	____
	The implementation of the Safe Dates curriculum has not been well coordinated at this school	____
	If questions arise about implementing the Safe Dates program, teachers have ready access to needed information	_______
	Teachers who are responsible for implementing the Safe Dates curriculum have a clear understanding of their roles and responsibilities	_______
	Teachers responsible for implementing Safe Dates are given the tools and resources they need to do so effectively	_______

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

	We do not have the resources necessary to implement the Safe Dates program on a long-term basis….	_____
	Teachers responsible for implementing the Safe Dates program know their efforts are appreciated by this school	_____
	The administration gets regular progress reports about the implementation of the Safe Dates curriculum	_____
	Often teachers feel pressured not to “rock the boat” by speaking their minds about the pros and cons of the Safe Dates curriculum	_____
	The Safe Dates curriculum is likely to be discontinued at this school when the study ends	_____
	The Safe Dates curriculum is contributing to the safety of the students enrolled in the course	_____
	I would be surprised if the school decided to stop offering the Safe Dates curriculum when this study ends	_____
	School administrators appear to like the Safe Dates curriculum	_____
	Teaching Safe Dates exactly as it was developed by experts is critical to getting expected results	_____
	After reviewing the curriculum guide, the average teacher will be well-equipped to do a good job implementing the Safe Dates curriculum	_____
	It is easy to correctly implement the Safe Dates curriculum on a consistent basis at this school	_____
	Safe Dates is being implemented in a way that departs significantly from what is recommended	_____
	The principal has been very supportive of this school's efforts to implement the Safe Dates curriculum.	_____
	The Safe Dates program provides students with knowledge and strategies that will help them reduce dating violence in the future	_____
	Those in charge of leading the effort to implement the Safes Dates curriculum lack some important skills	_____
	Technical assistance is available to teachers who are responsible for teaching the Safe Dates course.	_____
	The Safe Dates curriculum will have long-term benefits for the students enrolled in the course	_____
	I have been very supportive of this school's efforts to implement the Safe Dates curriculum	_____
	Little effort has been given to overcoming obstacles that get in the way of implementing the Safe Dates curriculum as prescribed	_____
	School administrators do a good job removing barriers that interfere with teaching the Safe Dates curriculum exactly as prescribed	_____
	This school has the resources necessary to support the initial implementation of Safe Dates	_____
	Top administrators provide encouragement to teachers involved in implementing the Safe Dates curriculum	_____
	The administration pays close attention to the progress being made related to implementing the Safe Dates program	_____

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

	Overall, parents seem to like the Safe Dates curriculum	_______
	The school has the resources to support the implementation of the Safe Dates curriculum BUT ONLY during the course of the study	______
	Students have been very supportive of this school's efforts to implement the Safe Dates curriculum	_______
	Not enough attention was given to monitoring the early stages of implementing the Safe Dates curriculum at this school	______
	The school does not have the resources necessary to support the implementation of the Safe Dates curriculum during the course of the study	______
	The incidence of dating violence is bound to decrease among students who take the Safe Dates course…..	_______

Instructions: Using the scale provided below, please indicate the extent to which each of the following describes the implementation of the Safe Dates curriculum at this school. Enter the number that most closely reflects your response in the space provided next to each phrase. Enter “0” if you don’t know.

No Extent/ Not at all	Very Small Extent	Small Extent	Moderate Extent	Considerable Extent	Great Extent	Very Great Extent		Don’t Know
1	2	3	4	5	6	7		0

To what extent….

	…have changes in school leadership hindered the implementation of the Safe Dates curriculum?	_____
	…has teacher turnover hindered the implementation of the Safe Dates curriculum?	_____
	…has lack of clarity about goals and plans hindered the implementation of the Safe Dates curriculum?	_____
	…has lack of clarity about how to implement parts of the Safe Dates curriculum hindered its overall implementation?	_____
	…has lack of resources hindered the implementation of the Safe Dates curriculum?	_____
	…have internal coordination problems hindered the implementation of the Safe Dates curriculum?	_____
	…has interference by outside groups hindered the implementation of the Safe Dates curriculum?	_____
	…has resistance from students hindered the implementation of the Safe Dates curriculum?	_____
	…have scheduling problems hindered the implementation of the Safe Dates curriculum?	_____
	…has resistance from key school personnel hindered the implementation of the Safe Dates curriculum?	_____
	…does this school continue to require technical assistance from outside experts in order to implement Safe Dates as prescribed?	_____
	…does this school possess the in-house expertise needed for implementing the Safe Dates curriculum in the future?	_____