Form Training Summary F Training Summary F Training Summary Form

TIS Training Summary Form

NCTSI EVALUATION

Training Summary Form—Completed by NCTSN Center Trainer

This training summary form should be completed for each training activity. If a training activity spans several days or weeks, this summary form should be completed after the last session and number of trainees should reflect the maximum number of individuals who attended one or more of the sessions.

1. Training dates (if training was 1 day, indicate the same date in both fields):

____/____/________ through ____/____/________

2. Number of training sessions: _____

3. Total duration of training:

1. Total number of days training was delivered (if training occurred across weeks, please indicate the number of days on which training sessions were held): _____

2. Total number of hours this training lasted: _____

4. Number of trainees who attended the training: _____

5. Name of training: ___________________________________________________________

6. Name of the NCTSN center that provided the training: ______________________________

7. Training delivery method (check one):

Presentation	Audio Presentation
Workshop	Webinar
Interactive Workshop	In-person Supervision/Consultation
Learning Collaborative Session	Audio/Video Supervision/Consultation

8. Primary agency and organizational role of trainees (Check all that apply):

School

Teachers

Counselors/Social Workers/Psychologists

Administrators

Juvenile justice agency

Probation officer

Provider

Administrator

Child welfare/foster care agency

Social Worker/Case manager

Administrator

Foster Parent

Birth Parent(s)

Youth

Mental health agency

Counselors/Therapists/Clinicians

Administrator

Substance abuse agency

Counselors/Therapists/Clinicians

Administrator

Community-based organization

Advocate

Case manager

Provider

Administrator

First-responder organization

EMT

Provider

Administrator

Health/primary care organization

Nurse

Physician

Medical Assistant

Administrator

General Public

Family member

Caregiver

Other type of organization or individual (please describe: ________________________)

9. Were medical or continuing education units offered for participation in this training? (Check one)

Yes

No

Not applicable

10. Which of the following types of trauma were targeted by this training? (Check all that apply)

Sexual abuse	Physical abuse
Neglect	Domestic violence
School violence	Community violence/crime
Refugee trauma	Historical trauma
War-related trauma	Disaster/terrorism related trauma
Medical trauma	Grief-related trauma
Secondary trauma/vicarious trauma	Complex trauma
Other (please describe:_______________________)

11. How would you broadly characterize the content area of the training? (Check all that apply)

Awareness and education	Screening
Referrals/triaging	Assessment
Clinical intervention	Crisis intervention
Non-clinical intervention	Secondary trauma
Support service	Sensitivity related to interacting with trauma victims and families
Prevention	Cultural competence/cultural adaptation
Psychoeducation	Trauma-informed service delivery
Other (please describe:_______________________)

12. If this training focused on particular interventions or assessments, please check all that apply:

(Complete List will be drawn from the ESC/expert panel)

__TF-CBT

__ARC

__PCIT

__CPP

__Trauma Assessment Pathway

__Other: ___________

__Other: ___________

If other, please describe:

13. For topic areas a–m below, please indicate the degree to which each was included in this training.
(Check one box per topic area)

	Primary Focus of Training 1	Key Theme But Not the Primary Focus 2	Mentioned But Not Emphasized 3	Not Mentioned at All 4
Trauma screening and assessment for children/adolescents entering a system
General clinical practice guidelines and approaches for child/adolescent trauma treatment
Specific evidence-based or evidence-informed interventions for trauma-exposed children
Research, evaluation, and/or quality improvement data regarding assessing and/or treating child/adolescent trauma
	Primary Focus of Training 1	Key Theme But Not the Primary Focus 2	Mentioned But Not Emphasized 3	Not Mentioned at All 4
Training families, caregivers, and/or consumers about being involved in systems, services and supports
Training professionals about family, caregiver, and/or consumer involvement in systems, services and supports
Cultural sensitivity and appropriateness of child/adolescent trauma services and supports
Coordination across service systems
Child trauma-informed disaster and terrorism response
Community awareness about trauma and available services and supports
Available capacity across systems to provide trauma-informed services
Local, State, and Federal guidelines related to trauma services and supports
The existence, contents, or importance of a state-level trauma policy/position and/or planning to address child/adolescent trauma

14. Do you or the center plan to assess the outcomes of this training? Yes No

If yes, please describe how: ________________________________________________________

15. Training summary form completed by:

Trainer

NCTSN Center Program Staff, other than the Trainer

Evaluation Staff

Other (please specify): __________________________________________________

PLEASE ATTACH A COPY OF THE SIGN-IN/CONTACT INFO SHEET.

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