Evaluation of Expect Respect Support Groups
Facilitator Program
Implementation Fidelity Measure
2011
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-74, 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
When you complete the survey during winter break your responses should reflect the time from September 1 – December 15.
When you complete the survey after completion of the group your responses should reflect the time from January 15 - May 31
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; 7th 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 Expect Respect 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? (Only answer this question in survey during winter break)
5 – 10 new referrals
3 – 5 new referrals
Less than 3 new referrals;
How quickly were you provided with referrals?
(Only answer this question in survey during winter break)
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?
(Only answer this question in survey after group completion)
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 group focus on building healthy relationships?
Activities or discussion about building healthy relationships occurred in each session (relationships in group, family, with dating partners, friends, or at school, etc.).
Activities t or discussion about building healthy relationships occurred in most sessions.
Activities or discussion about building healthy relationships occurred in less than half of the sessions
Please identify other content or themes discussed:
________________________________________________________
To which extent did the content of group discussions focus on identifying warning signs and /or working through abusive relationships?
Content or discussion about abusive relationships occurred in each session (relationships in group, family, with dating partners, friends, or at school, etc.).
Content or discussion about abusive relationships occurred in most sessions.
Content or discussion about abusive 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.
If you rarely used discussion question from the curriculum please identify what other 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
If you rarely used activities suggested in the curriculum please identify what other 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
If you did not follow sequence of curriculum, please explain:
________________________________________________________________________________________________________________________
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?
______________________________________________________________________________________________________________________________________________________________________________________________________
| File Type | application/msword |
| File Title | Expect Respect Training – 11/10/05 |
| Author | psyjge |
| Last Modified By | its7 |
| File Modified | 2011-10-11 |
| File Created | 2011-09-09 |