OMB
2900-XXXX
Estimated Burden 10 minutes
Expiration Date: XX/XX/XXXX
Department of Veterans Affairs
Veterans Health Administration
Understanding PTSD for Family Caregivers: Feedback Survey
This information is collected in accordance with section 3507 of the Paperwork Reduction Act of 1995. Accordingly, we may not conduct or sponsor and you are not required to respond to a collection of information unless it displays a valid OMB number. We anticipate that the time expended by all individuals who complete this survey will average 10 minutes. This includes the time it will take to read instructions, gather the necessary facts and fill out the form. Customer satisfaction surveys are used to gauge customer perceptions of VA services as well as customer expectations and desires. The results of this survey will lead to improvement in the quality of service delivery by helping to shape the direction and focus of specific programs or services. Completion of this form is voluntary and failure to respond will have no impact on benefits to which you may be entitled.
1) PURPOSE OF SURVEY: VA is interested in feedback on the education programs it offers to Caregivers. Please take a moment to let us know your thoughts on the education program you recently attended as well as suggestions for future Caregiver education programs.
2) SELECTION: You were selected to receive this survey because you attended the Understanding PTSD for Family Caregivers program.
3) TIME: The survey is estimated to take 10 minutes to complete.
4) QUESTIONS: For content-related questions, please contact Paul Holmes at Paul.Holmes2@va.gov
5) HELP: If you have technical difficulty with this survey, please send a message to Nital.Patel@va.gov
How would you describe your role as a Caregiver?
Spouse
Parent
Child
Friend
Other
Please type in your role:
Please indicate your level of agreement with the following statements regarding the "Understanding PTSD for Family Caregivers" program.
Strongly Disagree |
Disagree |
Neutral |
Agree |
Strongly Agree |
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I
would
recommend
this
program
to
other
Caregivers
of
Veterans
The setting was conducive to my ability to learn.
I learned something new from the training program
I
was
satisfied
with
the
length
of
this
Caretaker
Education
program
I
was
satisfied
with
the
format
of
this
Caregiver
Education
Program
Overall, I was satisfied with the program.
Please
check
the
top
three
ways
you
would
like
future
Caregiver
education
programs
to
be
delivered.
Live Broadcast with other Caregivers participating
Webinar at a VHA site with other Caregivers participating
Webinar accessed from home computer
Telephone Conference call with Power Points
Live Stream to home computer
Other
What other way would you like future Caregiver education programs to be delivered?
The "Understanding PTSD for Caregivers" program provided information on the following topics. Please indicate both the level of usefulness of each of the topics below as well as whether you have had an opportunity to utilize any of the suggested strategies.
Did you try to use this information after attending the program?
Usefulness of Information
Common Barriers to Treatment (lack of awareness, stigma, fear)
c
Resiliency (social support, role models, purpose)
PTSD Symptoms & Triggers (irritability, withdrawal, TV, crowding)
Not
Somewhat Moderately Useful Very
Not
Useful
Useful Useful Useful Applicable
Responses to Nightmares
(calm voice, no touching)
Responses
to
Anger
(understand
cause
no
confrontation)
Stress Management
(relaxation
exercises,
practice
together
daily)
Grounding
(focus
on
the
here
and
now)
Treatment Options (trauma
focused,
family
and
couples
therapy
etc.)
Please indicate the level of importance for the following components of the Caregiver education program.
Please rank the importance of the following topics to your individual needs. Please indicate your ranking from 1 to 5 with "1= Most Important" and "5= Least Important". Please use each number only once.
Children living with a Parent with PTSD
Traumatic Brain Injury
Respite Care
Education Benefits for Veterans Caregivers and Children
Employment
If you think there are other topics that should be considered for future Caregiver programs, please specify below.
How often should we provide these trainings?
The "Question and Answer" section of the program
The presence of a VA mental health provider at your group meeting
The presence of other Caregivers in the room
Not Very Somewhat Moderately Important Very Important Important Important Important
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VA
Form
10-0495
SEP
2012
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
Author | Manuel, Howard L. |
File Modified | 0000-00-00 |
File Created | 2021-01-27 |