Facilitator Program Fidelity Measure

Attachment J

ERSG Facilitator Program Implementation Fidelity Measure

Please complete the survey once at the midpoint of your groups (or during winter break) and once after groups have ended. The survey prompts you to provide some information about yourself. Then you are asked to complete one survey per group. There are no right or wrong answers and your answers may differ according to the groups you are working with.

Form Approved

OMB No. 0920-0861

Exp. Date: 08/31/2013

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 may 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 (0920-0861).

Staff Code _____________

What is your highest degree?

• ₁ MSW or MA degree in a counseling-related field with appropriate licensure

• ₂ Bachelors degree ( or masters without licensure)

• ₃ Less than bachelors degree

What is your experience in working with teens?

• ₁ Experience facilitating teen groups for more than 5 years

• ₂ Experience facilitating teen groups for 2 - 5 years

• ₃ Experience facilitating teen groups for less than 2 years

What is your experience with facilitating Expect Respect Support Groups?

• ₁Experience facilitating Expect Respect groups for more than 3 years

• ₂Experience facilitating Expect Respect groups for 1 -3 years

• ₃First year facilitating Expect Respect groups

What is your experience in Sexual and Dating Violence Prevention ?

• ₁ Experience in SA/DV and prevention for more than 3 years

• ₂ Experience in SA/DV and prevention for more than 1 year

• ₃ First year working in SA/DV and prevention

Complete one survey per group/ school – once during winter break and once at the end of group

Facilitator code _____________________

School code _______________

Number of sessions provided at this point _____________________________

GETTING GROUPS STARTED

How well is your school liaison/contact person connected in the school?

• ₁ a member of school staff or faculty – someone with knowledge and access to school staff and administration

• ₂ not a school staff (e.g. Communities In Schools) – but someone with knowledge and access to school staff and administration

• ₃ someone without good knowledge or access to school staff and administration

Where are posters advertising Expect Respect Support Groups placed?

• in places where all students will see them

• in places where some students will see them

• no posters

How well was the staff orientation attended?

• all or almost all faculty and staff attended

• selected group attended (e.g. counselors; English teachers; 7^th grade team)

• low attendance out of the invited group

• no staff orientation provided

What was covered in the staff orientation ?

• Comprehensive: covered information about dating violence, risk factors, Expect Respect and referral criteria

• Brief: covered some program information and referral criteria

• no staff orientation provided

Did the principal sign the school agreement form ?

• presented and signed

• presented but not signed

• not used

Which Expect Respect program elements are provided at this school?

• Expect Respect support groups plus multiple additional program components selected (e.g. youth leadership, staff training, parent workshops, Changing Lives, classroom curriculum)

• Expect Respect support groups plus one additional program component

• Only Expect Respect support groups

To what extent were referrals to this particular Expect Respect support group appropriate?

• Mostly appropriate referrals

• Some inappropriate referrals

• Mostly referrals of students not appropriate for ERSG

How many new referrals did you receive in the first 4 weeks of the school year?

• 5 – 10 new referrals

• 3 – 5 new referrals

• Less than 3 new referrals;

How quickly were you provided with referrals?

• Adequate number of referrals (approximately 10) received in the first 4 weeks of the school year

• Slow referral process (between 5 and 10 referrals), with most referrals received between weeks 4 and 8 of school

• Few referrals (less than 5) and slow referral process in the first 8 weeks of school.

How many new referrals did you receive in the second semester of the school year?

• 5 – 10 new referrals

• 3 – 5 new referrals

• Less than 3 new referrals;

What is your average group size at this school?

• 6-10

• 4 – 6

• Less than 4

• inconsistent

Do you have a private and consistent location available to conduct groups?

• consistent and private location

• not always consistent location

• no private location

How often do you meet with the school contact person?

• Regularly before or after group sessions

• Occasionally

• Rarely or never

How do you get students to group?

• systematic easy way of getting students excused from class, such as the sample hall pass

• inconsistent or somewhat confusing system for class excuse

no system in place

• EXPECT RESPECT CURRICULUM (GROUP CONTENT)

To which extent did the content of group discussions focus on abusive or healthy relationships?

• Content or discussion about abusive or healthy relationships occurred in each session (relationships could be in families, dating relationships, friendships, work, etc.).

• Content or discussion about abusive or healthy relationships occurred in most sessions.

• Content or discussion about abuse or healthy relationships occurred in less than half of the sessions

Please identify other content or themes discussed:

________________________________________________________

To which extent did you use discussion questions suggested in the curriculum or similar questions?

• Discussion questions from the curriculum or similar questions used in all or most sessions

• Discussion questions from the curriculum or similar questions used in some sessions

• Discussion questions from the curriculum or similar questions rarely or never used.

Please identify what types of discussion questions you used:

________________________________________________________________________________________________________________________

To which extent did you use activities suggested in the curriculum or similar activities?

• Activities suggested in the curriculum or similar activities used all or almost all of the time

• Activities suggested or similar activities used some of the time

• Activities suggested or similar activities rarely or never used

Please identify what types of activities you used:

________________________________________________________________________________________________________________________

To which extent did you follow the sequence of topics in the curriculum?

• Followed sequence of topics in curriculum

• Changed sequence of curriculum for a few sessions

• Did not follow sequence of curriculum

How did you use group time?

• frequently used group time (beyond check in) to support individual members who are in distress or sharing feelings.

• occasionally used group time (beyond check in) to support individual members.

• used group time primarily for structured activities.

To which extent did you allow group members to direct the group session?

• frequently gave room for group members to raise questions and issues (or initiate discussion) about relationships that are relevant to them even if they are not planned in the curriculum.

• occasionally gave room to group members to raise questions and issues about relationships even if they are not planned in the curriculum.

• followed the curriculum sequence and structure

GROUP MEMBERSHIP

First Half of Sessions (to be completed during winter break)

• The group started out full or mostly full and a few new members were added in subsequent weeks.

• The group started out small and new members joined in subsequent weeks until the group is full

• A core group was never established, new members join and then leave.

Second Half of Sessions (to be completed after groups have ended)

• no new members after the halfway point

• one or two exceptions to this rule

• no boundaries to entrance and exit from the group – totally open

GROUP PROCESS

How often did you use check-in or icebreakers at the beginning of sessions?

• used for every session

• used sometimes

• not used for sessions

How much time did you spend on supporting and exploring personal experiences of group members?

• 30 minutes spent on general support, review of personal issues and experiences during sessions

• 15 – 30 minutes given to general support in multiple sessions

• Less than 15 minutes given to general support

How would you describe your role as facilitator at this point?

• facilitator talks less and allows group to initiate and lead discussion

• facilitator initiates discussion but then group takes the lead

• facilitator initiates most of the discussion and talks more as group members are passive and quiet

How would you describe the participation in this group?

• Participation is balanced (everyone participates more or less equally)

• Participation is semi-balanced, but some participants may dominate while others are often withdrawn

• Participation is very much dominated by a few participants

What is the level of support among participants?

• high level of support among participants

• moderate level of support among participants

• low level of support among participants

Do you see participants learning new skills and strategies at this point?

• Most participants demonstrate or report using new communication or problem solving strategies in relationships

• A few participants demonstrate or report using new communication or problem solving strategies in relationships

• Participants don’t demonstrate or report using new communication or problem solving strategies in relationships

To which extent do participants share personal experiences?

• Participants frequently share personal experiences and feelings in group

• Participants sometimes share personal experience and feelings in group

• Participants rarely or never share personal experiences and feelings in group.

What did group members learn or gain by being in this group? How were members in this group impacted by the program?

______________________________________________________________________________________________________________________________________________________________________________________________________