Attachments R-T Parent Program Fidelity Sessions 1,3,5

Form Approved

OMB No. 0920-0941

Exp. Date: 6/30/2015

Public reporting burden of this collection of information is estimated to average 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 Information Collection Review Office, 1600 Clifton Road NE, MS D-24, Atlanta, Georgia 30333; ATTN: PRA (0920-0941).

Attachment R:

Parent Program Fidelity 7th Grade Session 1

Dating Matters: Strategies to Promote Healthy Teen Relationships™ Initiative

Division of Violence Prevention

National Center for Injury Prevention and Control

Centers for Disease Control and Prevention

Parent Curriculum – 7th Grade, Session 1 – Parenting Positively?

Attendance Log

Implementer Name: Last Name: _________________________ First Name______________________ Initial:___

Implementer Survey ID: _______________________________ School Number: ____________________________

Program Year: _______________________________________ Session Number: ___________________________

Parent / Guardian Names – Last, First, Initial	Name of Child in Program	Name of Child in Program

Parent Curriculum – 7th Grade, Session 1 – Parenting Positively

Session Log

Implementer Name: Last Name: _________________________ First Name______________________ Initial:___

Implementer Survey ID: _______________________________ School Number: ____________________________

Program Year: _______________________________________ Session Number: ___________________________

Please indicate if you completed the following activities:

Activity	Yes	Yes w/ changes	No
Introduced Dating Matters™ for Parents Curriculum			
Welcomed parents and facilitated introduction			
Introduced Dating Matters™ for Parents curriculum			
Asked parents to think about something positive about their children			
Distributed Parent Handbooks and explained how they will be used			
Explained goals of Dating Matters™ for Parents			
Provided the overview of the sessions
Established general ground rules and expectations for the group			
Introduced the concept of ground rules and expectations to the group			
Facilitated a discussion on rules participants would like to implement for group behavior			
Facilitated icebreaker activity			
Presented on changes taking place during adolescence			
Introduced participants to changes occurring during adolescence			
Segued to a discussion on these changes			
Facilitated a discussion on the outcomes associated with giving in to pressures			
Discussed positive parent-child interaction			
Introduced the concept of “effective parenting” to participants			
Implemented the “Parenting Pie” activity			
Discussed skills participants could use to establish and enhance good parent-child relationships			
Delivered content on effective parent-child communication			
Introduced the section			
Reviewed the tips for successful communication using Slides 12-15			
Implemented “Communication Blockers” activity			
Summarized the discussion on effective communication			
Completed Session Recap			
Completed Home Session Overview			
Closed session			

Please indicate if any of the following challenges interfered with your ability to implement the session. Check all that apply.

Not enough time.	
I did not have the needed materials.	
Parents did not appear to understand the session.	
I was uncomfortable discussing some of the topics.	
Parents were uncomfortable discussing some of the topics.	
Some part of the session was difficult for parents (i.e., role plays, discussing relationship issues and topics, homework).	
Other more pressing session demands.	
Other – please specify____________________________________	

Describe any changes you made to the session activities.

_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Please think about today’s session and tell us your answers to the following questions. Circle the number that shows your opinion about each question.

1. How engaged were the parents in the session?

_________________________________________________________________________________________________

5

Fully Engaged

1

Not at all Engaged/Bored

2

3

Somewhat Engaged

4

2. Overall, how do you think the session went today, in terms of your facilitation and the participation of parents?

_________________________________________________________________________________________________

5

Excellent

1

Very Poor/ Horrible

2

Poor

3

Fair

4

Good

3. How well do you think the parents understood the session material?

_________________________________________________________________________________________________

5

Excellent/

Complete Understanding

1

Did Not Understand

2

Poor

3

Fair

4

Good

4. How well did the session material fit into the allotted time period? (check the box for the statement that is most applicable for this session)

• Session was too packed; not enough time to complete all activities and discussions

• Session was somewhat packet; able to complete most but not all activities and discussions

• Session was timed perfectly; able to complete all activities and discussions

• Session ended before 90 minutes were up; not enough material was provided for the session

Form Approved

OMB No. 0920-0941

Exp. Date: 6/30/2015

Public reporting burden of this collection of information is estimated to average 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 Information Collection Review Office, 1600 Clifton Road NE, MS D-24, Atlanta, Georgia 30333; ATTN: PRA (0920-0941).

Attachment S:

Parent Program Fidelity 7th Grade Session 3

Dating Matters: Strategies to Promote Healthy Teen Relationships™ Initiative

Division of Violence Prevention

National Center for Injury Prevention and Control

Centers for Disease Control and Prevention

Parent Curriculum – 7th Grade, Session 3 – Parenting By Example

Attendance Log

Implementer Name: Last Name: _________________________ First Name______________________ Initial:___

Implementer Survey ID: _______________________________ School Number: ____________________________

Program Year: _______________________________________ Session Number: ___________________________

Parent / Guardian Names – Last, First, Initial	Name of Child in Program	Name of Child in Program

Parent Curriculum – 7th Grade, Session 3 – Parenting By Example

Session Log

Implementer Name: Last Name: _________________________ First Name______________________ Initial:__­__

Implementer Survey ID: _______________________________ School Number: ____________________________

Program Year: _______________________________________ Session Number: ___________________________

Please indicate if you completed the following activities:

Activity	Yes	Yes w/ changes	No
Welcomed participants back			
Implemented icebreaker activity			
Facilitated brief review of general ground rules			
Facilitated review of Session 1			
Facilitated review of in-home session (Session 2)			
Introduced Session 3			
Discussed healthy and unhealthy relationship behaviors			
Completed Activity 1: “Healthy vs. Unhealthy Relationships”			
Discussed healthy and unhealthy relationship behaviors using Slides 1-2			
Segued to a discussion of teen dating violence			
Completed Activity 2: “How Does This Apply to Me?”			
Continued the discussion of teen dating violence using Slides 5-6			
Presented and discussed Video 1: “Break the Silence: Stop the Violence”			
Discussed the role of parents as relationship models			
Segued to a discussion on the role of parents as relationship models			
Referenced the list of resources for parents in the Parent Handbook			
Completed Activity 3: “Relationship Scenarios”			
Presented and discussed Video 2: “Children See, Children Do”			
13. Completed Session Recap			
14. Completed Home Session Overview			
Closed session			

Please indicate if any of the following challenges interfered with your ability to implement the session. Check all that apply.

Not enough time.	
I did not have the needed materials.	
Parents did not appear to understand the session.	
I was uncomfortable discussing some of the topics.	
Parents were uncomfortable discussing some of the topics.	
Some part of the session was difficult for parents (i.e., role plays, discussing relationship issues and topics, homework).	
Other more pressing session demands.	
Other – please specify____________________________________	

Describe any changes you made to the session activities.

_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Please think about today’s session and tell us your answers to the following questions. Circle the number that shows your opinion about each question.

7. How engaged were the parents in the session?

_________________________________________________________________________________________________

5

Fully Engaged

1

Not at all Engaged/Bored

2

3

Somewhat Engaged

4

8. Overall, how do you think the session went today, in terms of your facilitation and the participation of parents?

_________________________________________________________________________________________________

5

Excellent

1

Very Poor/ Horrible

2

Poor

3

Fair

4

Good

3. How well do you think the parents understood the session material?

_________________________________________________________________________________________________

5

Excellent/

Complete Understanding

1

Did Not Understand

2

Poor

3

Fair

4

Good

8. How well did the session material fit into the allotted time period? (check the box for the statement that is most applicable for this session)

• Session was too packed; not enough time to complete all activities and discussions

• Session was somewhat packet; able to complete most but not all activities and discussions

• Session was timed perfectly; able to complete all activities and discussions

• Session ended before 90 minutes were up; not enough material was provided for the session

Form Approved

OMB No. 0920-0941

Exp. Date: 6/30/2015

Public reporting burden of this collection of information is estimated to average 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 Information Collection Review Office, 1600 Clifton Road NE, MS D-24, Atlanta, Georgia 30333; ATTN: PRA (0920-0941).

Attachment T:

Parent Program Fidelity 7th Grade Session 5

Dating Matters: Strategies to Promote Healthy Teen Relationships™ Initiative

Division of Violence Prevention

National Center for Injury Prevention and Control

Centers for Disease Control and Prevention

Parent Curriculum – 7th Grade, Session 5 – Parenting Skillfully

Attendance Log

Implementer Name: Last Name: _________________________ First Name______________________ Initial:___

Implementer Survey ID: _______________________________ School Number: ____________________________

Program Year: _______________________________________ Session Number: ___________________________

Parent / Guardian Names – Last, First, Initial	Name of Child in Program	Name of Child in Program

Parent Curriculum – 7th Grade, Session 5 – Parenting Skillfully

Session Log

Implementer Name: Last Name: _________________________ First Name______________________ Initial:___

Implementer Survey ID: _______________________________ School Number: ____________________________

Program Year: _______________________________________ Session Number: ___________________________

Please indicate if you completed the following activities:

Activity	Yes	Yes w/ changes	No
Welcomed participants back and facilitated re-introductions			
Facilitated brief review of general ground rules			
Facilitated review of Session 3			
Facilitated review of in-home session (Session 4)			
Introduced Session 5			
Completed discussion on parental supervision			
Facilitated a discussion of parental supervision using slides 1-4			
Facilitated a discussion of supervising children’s use of electronic media			
Completed discussion on other risks faced by adolescents			
Facilitated a discussion on other teen risk behaviors (e.g., alcohol, drugs) using slides 5-6			
Emphasized the parent’s role in the prevention of risky behaviors			
Completed a discussion on conflict resolution			
Facilitated a discussion on conflict resolution			
Presented the 4-step plan to resolve conflicts using slides 7-10			
Briefly demonstrated the conflict resolution skills using the provided scenario and script			
Implemented the role-play on conflict resolution
Completed Session Recap			
Completed Home Session Overview			
Closed session			

Please indicate if any of the following challenges interfered with your ability to implement the session. Check all that apply.

Not enough time.	
I did not have the needed materials.	
Parents did not appear to understand the session.	
I was uncomfortable discussing some of the topics.	
Parents were uncomfortable discussing some of the topics.	
Some part of the session was difficult for parents (i.e., role plays, discussing relationship issues and topics, homework).	
Other more pressing session demands.	
Other – please specify____________________________________	

Describe any changes you made to the session activities.

_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Please think about today’s session and tell us your answers to the following questions. Circle the number that shows your opinion about each question.

13. How engaged were the parents in the session?

_________________________________________________________________________________________________

5

Fully Engaged

1

Not at all Engaged/Bored

2

3

Somewhat Engaged

4

14. Overall, how do you think the session went today, in terms of your facilitation and the participation of parents?

_________________________________________________________________________________________________

5

Excellent

1

Very Poor/ Horrible

2

Poor

3

Fair

4

Good

3. How well do you think the parents understood the session material?

_________________________________________________________________________________________________

5

Excellent/

Complete Understanding

1

Did Not Understand

2

Poor

3

Fair

4

Good

12. How well did the session material fit into the allotted time period? (check the box for the statement that is most applicable for this session)

• Session was too packed; not enough time to complete all activities and discussions

• Session was somewhat packet; able to complete most but not all activities and discussions

• Session was timed perfectly; able to complete all activities and discussions

• Session ended before 90 minutes were up; not enough material was provided for the session