BB Student Program Fidelity 7th Grade Session 2

Form Approved

OMB No. 0920-XXXX

Exp. Date:

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-XXXX).

Attachment BB:

Student Program Fidelity 7th Grade Session 2

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

Student Curriculum – 7th Grade, Session 2 – Review

Attendance Log

Implementer Name: _________________________ Implementer ID: ___________________

School ID: ____________________________ Session ID: _________________

Classroom ID:_____________________________ Program Year: ____________________

Please have each student sign initials next to their name to indicate attendance to the session

Student Names (Pre-Typed)	Student ID (pre-typed)	Student Initials for Present

S tudent Curriculum – 7th Grade, Session 2 – Review

Implementer Name: _____________________ Implementer ID: ___________________

School ID: ____________________________ Session ID: _________________

Classroom ID:___________________________

Program Year: ____________________ Time lesson began: ___________

Date: __________________________ Time lesson ended: ___________

Please indicate if you completed the following activities:

Activity	Yes	Yes w/ changes	No
Briefly reviewed Session 1			
Explained that Session 2 will cover unhealthy relationships	f		
Explained that relationships may sometimes make us feel upset, hurt, disappointed, etc.			
Read the definition of dating violence and the three types of dating violence (Physical, Sexual, and Emotional) as a class			
Read the categories of emotional violence as a class			
Gave instructions for Activity 1			
Completed Activity 1			
Gave instructions for Activity 2			
Completed Activity 2 and provided brief explanations for each myth or fact			
Explained that the Dating Matters program will give students some tools to prevent dating violence and to get help if they experience dating violence			
Discussed the influence of media on people’s beliefs about men and women			
Gave instructions for Activity 3			
Ensured that students analyzed a media image in small groups			
Discussed how expectations about men and women can lead to dating violence			
Recapped Session 2			
Assigned the homework assignment
Previewed the concept of dealing with upsetting feelings in Session 3			

Describe any changes you made to the session activities (please identify which activity you are describing by number).

Please indicate if you experienced any of these challenges that interfered with implementing today’s session.  Check all that apply.

Not enough time	
I did not have the needed materials	
I was uncomfortable discussing some of the topics	
Students were uncomfortable discussing some of the topics	
Some part of the session was difficult for students (e.g., role plays, reading aloud, worksheets)	
Classroom behavior management issues	
Other more pressing classroom demands	
Other – please specify____________________________________	

Please check the extent to which the students were engaged in today’s lesson on the following measures:

Most students…	Strongly Agree	Agree	Don’t Know	Disagree	Strongly Disagree
Asked relevant questions.					
Suggested solutions to scenario problems.					
Responded correctly to questions.					
Distracted other students.					
Participated extensively in discussions.					
Discouraged other students from participating.					

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 well do you think the students understood the session material?

1  Not at all

2  A little

3  A lot

4  Completely

2. How well did the session material fit into the allotted time period?

1 Session was too packed/not enough time to complete all activities

2 Session was somewhat packed/able to complete most but not all

3 Session was just right

4 Not enough material/session ended before class period completed