CDC Word@Health Train-the Trainer Trainee Technical Assistance Survey

Form Approved

OMB No. 0920-XXXX

Exp. Date: XX-XX-XXXX

CDC Work@Health^TM Train-The-Trainer Trainee Technical Assistance Survey

Public reporting 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 Reports Clearance Officer, 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0920-XXXX).

Respondents/Sources	Method	Content	Timing	Respondents	Time per respondent
Training participant	Work@Health™ Train-the-Trainer TA Participant Online Survey (conducted by PHMC and RTI)	Extent of TA participation Satisfaction with TA Perceived utility of TA	Two times: 4-7 months after formal training; and 12-15 months post training	60	0.25 hrs

Introduction

This online survey asks about your participation in and your opinions about Work@Health™ technical assistance. This survey, which should take about 15 minutes to complete, is funded by the Centers for Disease Control and Prevention and is being conducted by the Public Health Management Corporation (PHMC) and RTI International (RTI). PHMC is a non-profit, public health institute located in Philadelphia. RTI is an independent, non-profit organization headquartered in Research Triangle Park, NC.

Informed Consent

Before you get started, we’d like to give you some more information to help you decide whether you would like to participate.

• This project is funded by the Centers for Disease Control and Prevention. Many parts of this project are being managed by the ASHLIN Management Group (ASHLIN). ASHLIN is a private sector consulting firm with a focus in the area of health and human services based in Greenbelt, MD. They are helping CDC implement the Work@Health™ program. The Public Health Management Corporation (PHMC), a non-profit, public health institute located in Philadelphia, PA is conducting this survey. Other parts of the project are being managed by Research Triangle Institute International (RTI). RTI is an independent, non-profit institute headquartered in Research Triangle Park, NC. RTI provides technical services to clients worldwide. They are helping CDC evaluate the Work@Health™ program.

• You were asked to complete the survey because of your participation in the Work@Health™ Program.

• Your participation in this survey is voluntary. In the course of this survey, you may refuse to answer specific questions. You may also choose to end the survey at any time.

• The survey is designed to take about 15 minutes.

• All of the comments you provide will be maintained in a secure manner. We will not disclose your responses or anything about you unless we are compelled by law. Your responses will be combined with other information we receive and reported in the aggregate as feedback from the group. In our project reports, your name will not be linked to the comments you provide in this survey.

• There are no right or wrong answers or ideas—we want to hear about YOUR experiences and opinions.

• CDC is authorized to collect information for this project under the Public Health Services Act.

• There are no risks or benefits to you personally for participating in this survey.

• We are interested in your comments so that we can improve the Work@HealthTM program for future participants. Please feel free to contact Dr. Laurie Cluff at RTI. Her toll-free number is 1-800-334-8571 x 6514. You can also call RTI’s Office of Research Protection and Ethics toll-free at 1-866-214-2043.

Note: In this survey, technical assistance (TA) refers to all Work@Health™ online, telephone, and in-person support services that occurred after the formal training sessions ended.

We are asking you to complete this survey as part of your participation in the Work@Health™ program.

Your responses will help us to assess the effectiveness of the Technical assistance (TA) support services that were available to all Work@Health™ participants following the formal training. Your feedback will help us to improve the future TA.

In this survey, technical assistance (TA) refers to all Work@Health™ online, telephone, and in-person support services that occurred after the formal training sessions ended.

1. Since you completed the Work@Health™ Train-the-Trainer course, how often have you received technical assistance from your training instructor?

   1. Never

   2. Less than once a month

   3. About once a month

   4. 2-3 times a month

   5. Once a week or more

   6. Not sure

Q-2a. How useful was the technical assistance you received in recruiting and training five employers on the Core Curriculum? Please rate usefulness of the TA for each component below.

TA Support Service	Did Not Use	Not Useful	Somewhat Useful	Useful	Extremely Useful
Planning and Preparation Component
Budgeting	1	2	3	4	5
Marketing	1	2	3	4	5
Recruiting	1	2	3	4	5
Communication Strategy	1	2	3	4	5
Delivery Component
Planning to Deliver Training Using the Hands-On Model	1	2	3	4	5

Q-2b. Did you provide feedback to your peers using the comments section of YouTube?

1. Yes

2. No

Q-2c. Did you provide feedback to the Work@Health™ curriculum team using the comments section of YouTube?

1. Yes

2. No

Q-2d. Did you participate in the debrief component of the TA?

3. Yes

4. No [go to Q-2f]

Q-2e. How useful was the feedback you received from your instructor during the debrief?

1. Not useful

2. 

   [continue to Q-3]

   Somewhat useful

3. Useful

4. Extremely Useful

Q-2f. If you did not participate in the debrief please describe the reason(s)

__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Q-3. Please rate the Work@Health™ technical assistance you received OVERALL on the following dimensions:

	Poor	Fair	Good	Very Good	Excellent
Overall quality of the technical assistance provided (e.g. clarity, content)	1	2	3	4	5
Usefulness of the technical assistance resources and information.	1	2	3	4	5
Appropriateness of the materials and resources used during technical assistance	1	2	3	4	5
Promptness of the feedback you received from instructors/coaches	1	2	3	4	5
Amount of time your instructor(s)/coach(es) spent on providing technical assistance	1	2	3	4	5
Dependability of the instructor(s)/coach(es) (e.g. did they do what they said they would do within the timeframe discussed?)	1	2	3	4	5
The overall quality of the instructor(s)/coach(es) and his/her knowledge of the subject matter (e.g. effectiveness, expertise in program development and implementation)	1	2	3	4	5

Q-4. Is there anything about the technical assistance support services that you would change?

1. Yes, I would change it significantly

2. Yes, I would make minor changes

3. No, I would not make changes [go to Q-5]

Q-4a. Please describe what you would change.

__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Q-5. What additional topics or support services would you have liked to see included as part of the technical assistance?

______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Q-6. Please provide up to three examples of goals you have accomplished because of the TA support you received from the Work@Health™ program

________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________

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