Parent/Guardian Survey

Attachment H:

Educator Outcome Survey

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

Form Approved

OMB No. 0920-XXXX

Exp. Date:

Public Reporting burden of this collection of information is estimated at 30 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-24, Atlanta, GA 30333; Attn: PRA (0920-XXXX).

Evaluation of CDC’s Dating Matters™:

Strategies to Promote Healthy Teen Relationships Initiative

EDUCATOR SURVEY

Instructions

• Use a pencil or blue or black pen.

Fill bubbles completely. Like this: 

Do not mark answers with ’s or ’s.

1. Name of School: _________________________________

If you work at more than one school, please complete the survey based on the school with which

you are most familiar, and fill in this bubble 

2. How long have you been at this school?

 This is my first year

 This is my second year

 This is my third year

 I have been at this school four or more years

3. What is your role?

 Teacher  Custodian

 Administrator  Lunch room worker

 Paraeducator  Office staff

 Bus driver  Other staff

4. Sex:

 Male

 Female

5. What is your race?

 American Indian or Alaska Native

 Asian

 Black or African American

 Native Hawaiian or other Pacific Islander

 White

 Other race

6. Are you Hispanic or Latino?

 Yes

 No

Safe Schools Survey

Please read each statement carefully, then indicate how strongly you agree or disagree with the statement. Answer questions based on the current school year.

	Strongly Agree	Agree	Neutral	Disagree	Strongly Disagree
1. Teachers respect students in this school.					
2. I feel safe before and after school while on school grounds.					
3. Parents are involved in activities at school.					
4. Students use drugs or alcohol outside of school.					
5. Teachers work hard to make every student successful.					
6. Students enjoy learning here.					
7. I feel that I belong at this school.					
8. Groups of students cause problems or conflicts at school.					
9. Students feel comfortable telling a teacher or an administrator about potential violence.					
10. I have seen a gun at school this year.					
11. I feel safe in the school hallways.					
12. Most students are proud of this school.					
13. Teachers have input in decision-making at this school.					
14. Some students are regularly hassled by other students.					
15. Teachers care about student learning at this school.					
16. Teachers and administrators supervise the halls during passing time.					
17. I have seen students smoking at school or on school grounds.					
18. Teachers praise students when they have done well.					
19. Arguments among students are common at school.					
20. Teachers enjoy teaching here.					
21. I have seen a knife at school (not including a cafeteria knife).					
22. Teachers listen carefully to what students have to say.					
23. Name-calling, insults, or teasing happen regularly at school.					
24. Students respect teachers in this school.					
25. Parents are made to feel welcome at this school.					
26. Students use alcohol or drugs at school.					
27. I am proud of this school.					
28. Students regularly cheat on tests or assignments.					
29. Students cut classes or are absent regularly.					
30. Overall, I feel that this school is a safe school.					
31. I have seen students with drugs or alcohol at school.					
32. Administrators listen to what teachers have to say.					
33. I feel safe in my classroom(s).					
34. Robbery or theft of school property over $10 in value is common.					
35. Students are generally treated fairly at this school.					
36. Sale of drugs occurs on school grounds.					
37. Students cooperate with teacher requests.					
38. Physical fighting or conflicts happen regularly at school.					
39. Most students are getting a good education at this school.					
40. Threats by one student against another are common at school.					

Attitudes toward TDV

How strongly do you agree or disagree with the following statements? Please choose one answer for each line.
In this school, students generally think that…	Strongly Agree	Agree Somewhat	Disagree Somewhat	Strongly Disagree
1. It is ok for a boy to hit his girlfriend if she did something to make him mad.				
2. It is ok for a boy to hit his girlfriend if she insulted him in front of friends.				
3. Girls sometimes deserve to be hit by the boys they date.				
4. A girl who makes her boyfriend jealous on purpose deserves to be hit.				
5. Boys sometimes deserve to be hit by the girls they date.				
6. Sometimes boys have to hit their girlfriends to get them back under control.				
7. It is ok for a boy to hit a girl if she hit him first.				
8. It is ok for a girl to hit a boy if he hit her first.				

Visibility of TDV

In your school, how often do you see students who you think might be dating or somehow “involved”:		Never	Seldom	Sometimes	Often
1.	Slap, push, pinch, pull hair or shove each other				
2.	Hit with a fist, kick, or beat each other up				
3.	Name call, humiliate, or belittle each other				
4.	Verbally threaten each other				
5.	Verbally harass their partner in a sexual way				
6.	Touch their partner sexually in a way that seemed unwanted				
7.	Send and/or receive text messages with sexual content				

Problems (Adapted from Add Health)

Below is a list of problems that confront some adolescents today. Please tell us whether you think each is a big problem, a small problem, or no problem at all for your school community.

		Big Problem	Small Problem	No Problem At All
1.	Smoking or tobacco use			
2.	Drug use			
3.	Alcohol use			
4.	Gang violence			
5.	Sexual harassment			
6.	Teen pregnancy			
7.	Vandalism/thieving			
8.	Eating disorders			
9.	Racial conflict			
10.	Dating violence			
11.	Stress or pressure			
12.	Bullying			

Educator Questions for Dating Matters Online Training

1. In the last 12 months, have you taken the Dating Matters online training for educators?

 Yes

 No

If yes, please indicate how strongly you agree or disagree with the following statements:

	Strongly Agree	Somewhat Agree	Somewhat Disagree	Strongly Disagree
2. Before taking this training, I believed teen dating violence could be prevented.				
3. Following this training, I believe that teen dating violence can be prevented.				
4. I see teen dating violence prevention programs and policies fitting within my school.				
5. Following this training, I plan to talk with my school administrator and/or other educators about how we can incorporate teen dating violence prevention into the curriculum and school policies.				
6. Before taking this training, I believed educators played an important role in teen dating violence prevention.				
7. Following this training, I believe educators can play an important role in teen dating violence prevention.				
8. After taking this training, I see the importance of adults modeling respectful relationships for youth.				
9. After taking the training, I plan to incorporate teen dating violence prevention into my classroom lessons.				
10. Before taking the training, I felt comfortable discussing teen dating violence with my students.				
11. After taking the training, I feel more confident in my ability to discuss teen dating violence with my students.				