Follow-Up Prevention Coordinator Survey

Attachment U

Follow-up 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 5 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).

Follow-Up Prevention Coordinator Survey

Thank you for participating in the Evaluation of the Safe Dates Project. This is the last survey you will be asked to complete. It will take less than 5 minutes of your time. Information you provide will be combined with responses from other schools, and no identifying information about you or your school will be linked to this information.

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)