Appendix A.
State Deaf-Blind Project Grantee Questionnaire
OPENING SCREEN
OSEP State Deaf-Blind Projects:
Phase
II of the IDEA National Evaluation of the
Technical Assistance
& Dissemination Program:
Thank you for logging on to complete the State Deaf-Blind Project survey.
This survey is being conducted by Westat as part of the National Evaluation of the Technical Assistance and Dissemination (TA&D) Program. We are gathering the same information from all State Deaf-Blind Projects in order to describe the activities of the project, who you serve and how you identify children and youth for services, your work in different initiatives, and collaboration both with other state projects and with other agencies and organizations. Your responses will help improve opportunities to receive support for those who work with children and youth with deafblindness.
All information gathered for this study will be kept confidential and will be used only for research purposes. The information collected for this study will be used only for statistical purposes and may not be disclosed or used, in identifiable form, for any other purpose except as required by law (Public Law 107-279, Section 183).
We
estimate that this survey will take approximately 45 minutes to
complete.
You can start and stop at any time and your
information will be saved.
As you respond to questions, please keep the following in mind:
By targeted technical assistance, we mean individualized assistance that was either
(a) focused on a particular child or children (i.e., child-specific support) or
(b) focused on a particular staff member or members working with deafblind children and that was direct and intensive in nature.
Please only include technical assistance which was provided either on site or through distance technology.
Include services provided to individuals of all ages.
While some activities of your project may have existed prior to the new funding cycle, please focus on the time period of October 2013 through now in responding to general questions about your project.
If you are uncertain how to answer any particular question, at any time, feel free to contact the project at [email protected] or toll-free at 1-800-XXX-XXXX and the survey specialist assigned to your state will get back to you right away.
Thank you for making this evaluation a success!
According to the Paperwork Reduction Act of 1995, no persons are required to respond to this voluntary collection of information unless such collection displays a valid OMB control number. The valid OMB control number for this information collection is 1850-XXXX. The time required to complete this information collection is estimated to average 45 minutes, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you have any comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: U.S. Department of Education, Washington, D.C. 20202-4537. If you have comments or concerns regarding the status of your individual submission of this form, write directly to: Meredith Bachman, U.S. Department of Education, Institute of Education Sciences, 555 New Jersey Avenue, NW, Suite 500J, Washington, D.C. 20208, or email [email protected].
Frequently Asked Questions (FAQs)
Navigating
the Survey
Navigate through the survey by answering each question and clicking the 'Save and Continue' button. When you click the 'Save and Continue' button, it will save your response and forward you to the next question. You may return to a prior question at any time by clicking on the appropriate question on the Section Guide to the left of the screen. When you reach the final submission page, please review your responses on the completed survey before the data are submitted. You cannot change your responses after the completed survey has been submitted. After submitting the data, you will be directed to the final screen so that you can print a copy of your completed survey for your records.
Navigation
Key:
PLEASE NOTE:
The 'back' arrow on your browser has been disabled. Use the 'Save & Continue' button and the question guide to move through the survey.
Your session will time out after 30 minutes of inactivity and you will be returned to the login screen.
Do
I have to complete the survey all at one time? No.
You can sign in and out of the website as many times as needed to
complete the survey. However, if you need to stop before finishing
the survey, please be sure to click on the 'Save & Continue'
button before signing out so that your responses(s) on that page will
be saved. Once you have finished and submitted your survey, you will
no longer have access to it.
Can
I skip a question?
Yes, you may skip any question in the survey that you cannot or do
not wish to answer. To skip a question, leave the question blank and
then click the 'Save & Continue' button to proceed.
Can
I go back to a question that I have already answered or skipped?
Yes. You may return to any answered or skipped question by clicking
on the appropriate question on the question guide found on the left
side of the screen. If you wish to change your response, be sure to
click the 'Save & Continue' button after you make any changes.
Can
I print individual questions? Yes.
You may print an individual page at any time by using your computer’s
usual method of printing (e.g., using the Command-P or Ctrl-P key
combination).
Do
I have to answer all the questions? You
will automatically be skipped past some questions that do not apply
to your situation, depending upon your answer to an earlier question.
Please try to answer all questions that are relevant for your
project.
Can
I have a colleague complete some of the questions instead of me? Yes.
Certain questions may require the help of others. You may either
share your login and password with these individuals, which will give
them full access to the survey, or you can print off specific
questions and fill in the responses yourself at a later time.
Can
I print a copy of the questionnaire when I am finished? Yes.
Once you have completed the survey, you will have the option to print
a copy of your responses before submitting it to Westat. This will
allow you to review all your answers and make any necessary changes.
You will also be able to print a copy for your records after
submitting it electronically to Westat.
Can
I obtain a paper version of the questionnaire? Yes.
If you would like to see a paper version for reference purposes, you
can download a PDF version by clicking the link at the top of the
page that says 'Download PDF.'
Is
the system secure?
System security is ensured through the following steps: 1) Login and
password validation for entry into the system, 2) The use of Secure
Socket Layers (SSL) for encryption of data packets, and 3) Data
storage in a Data Zone that is not accessible through the Westat
Firewall system.
Who should I contact if I have a question? The Westat project team can be reached at [email protected] or by phone at 1-888-xxx-xxxx. When sending emails, in addition to the question, please be sure to include your name and a phone number where you can be reached.
Project Structure and Model of TA
Which of the following best describes the administrative location of your state project? Select one.
Housed in the SEA
Housed in a university
Housed in a private agency or center
Housed in a state school for the deaf and/or blind
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Which best describes the way in which your project provides targeted TA in schools and homes? Select one.
Our project does not provide targeted TA in homes or schools
Targeted TA is delivered primarily by project staff
Targeted TA is delivered primarily by individuals who are not project staff (e.g., regional teams not funded by the project)
Child-specific TA is delivered equally by project and non-project staff
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Check whether your project receives any of the following in-kind support and whether it comes from a) your project’s fiscal agent or home agency, b) from your SEA (if it is not your fiscal agent or home agency), or c) from other entities, such as community partners. Check all that apply.
If this support varies from year to year, think about the first year of your project.
Include only support that comes to your project, or passes through your project (e.g., if your state supports parents to attend trainings but provides these stipends to parents directly, do not include them below, but if your state sponsors families and provides this money to the project to distribute, it should be included.)
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From your project’s fiscal agent or home agency |
From the SEA, if SEA is not your project’s fiscal agent or home agency |
From another entity |
Not applicable |
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Child Count Data
Based on the data you submitted to NCDB for the Child Count in May 2014, please indicate how many children and youth with deafblindness your state had in each of these categories:
Age birth-2 |
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3-5 |
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6-11 |
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12-17 |
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18-21 |
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Over 21 |
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Since October 2013, how many children and youth have received child-specific TA, either in person or through distance technology, from your project?
Age birth-2 |
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3-5 |
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6-11 |
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12-17 |
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18-21 |
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Over 21 |
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TA Recipients
Below is a list of possible individuals who may be served by your Project. Please check all to whom you have provided targeted TA since October 2013. Note that your response to this question is not expected to include TA or dissemination products that might be accessed without your knowledge.
Families/Caregivers
Parents/guardians
Siblings
Extended family members (e.g., grandparents)
Non-familial caregivers (e.g., day care or after school providers)
School/Campus level
School/campus administrators
Special education teachers
General education teachers
Related service providers (e.g., PT, OT, SLP, nurses, social workers, interpreters)
Paraprofessionals/Paraeducators and support service providers (excluding trained Interveners)
Interveners
Peers of students
District/county/regional level
District Special Education Directors and other administrators
Itinerant vision and hearing staff and/or audiologist employed by and working at the district level
Local early intervention service providers
Administrators of local Part C programs
County Service Agencies
Staff of state early intervention/Part C lead agencies
Regional consultants
State level and others
State Department of Education (SEA) Part B personnel
State Part C lead agency personnel
Agencies/organizations serving children or youth who are deafblind (includes parent organizations)
Private day care providers
Hospitals or pediatric medical day cares
University administrators, faculty, and students
Researchers
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Looking at all the customers you checked, which are the three customers that have received your greatest time and financial resources for targeted TA since October 2013? [Respondent will only see the items checked from the question above]
Families/Caregivers
Parents/guardians
Siblings
Extended family members (e.g., grandparents)
Non-familial caregivers (e.g., day care or after school providers)
School/Campus level
School/campus administrators
Special education teachers
General education teachers
Related service providers (e.g., PT, OT, SLP, nurses, social workers, interpreters)
Paraprofessionals/Paraeducators and support service providers (excluding trained Interveners)
Interveners
Peers of students
District/county/regional level
District Special Education Directors and other administrators
Itinerant vision and hearing staff and/or audiologist employed by and working at the district level
Local early intervention service providers
Administrators of local Part C programs
County Service Agencies
Staff of state early intervention/Part C lead agencies
Regional consultants
State level and others
State Department of Education (SEA) Part B personnel
State Part C lead agency personnel
Agencies/organizations serving children or youth who are deafblind (includes parent organizations)
Private day care providers
Hospitals or pediatric medical day cares
University administrators, faculty, and students
Researchers
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For
children and youth age 6-21 only,
how are children and youth referred to your project for
child-specific
TA?
For each of these options, please indicate the approximate
percentage of all referrals that are generated this way. You do not
need to consult your records; please just provide an estimate.
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Approximate Percentage |
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% |
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Total |
100% |
For many reasons, children and youth identified with deafblindness may not receive technical assistance from state projects. For your project, please indicate how true each of these reasons is in explaining why a child or youth may not receive child-specific TA.
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Not at all true |
Occasionally true |
Often true |
Very often true |
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TA Activities
Please check all products or services that your project provides.
Product Development and Dissemination
Information on our website or Facebook page
Product development
Listservs or e-lists
Email or telephone consultation
Dissemination of CD/DVDs
Online training modules
Newsletters
Technical Assistance and Training
Child-specific TA in the home
Child-specific TA in school settings
Child-specific TA through distance technology
Staff-specific intensive TA, e.g., designed to meet staff needs and build capacity but not child specific
Statewide or regional training (e.g., inservice, workshops, workgroups, seminars, symposia, institutes, forums)
Training via web-conferencing, webinars
Family leadership or family-focused training
Family support
Assistance in connecting families with one another
Participate on task forces and advisory boards
From
among the services and activities your project provides, check those
for which demand exceeds your resources. [Respondent
will only see the items checked from the question above]
Product Development and Dissemination
Demand
does not exceed resources for any of our Product Development or
Dissemination activities.
Information on our website or Facebook page
Product development
Listservs or e-lists
Email or telephone consultation
Dissemination of CD/DVDs
Online training modules
Newsletters
Technical Assistance and Training
Demand does not exceed resources for any of our Technical Assistance or Training activities.
Child-specific TA in the home
Child-specific TA in school settings
Child-specific TA through distance technology
Staff-specific intensive TA, e.g., designed to meet staff needs and build capacity but not child specific
Statewide or regional training (e.g., inservice, workshops, workgroups, seminars, symposia, institutes, forums)
Training via web-conferencing, webinars
Family leadership or family-focused training
Family support
Assistance in connecting families with one another
Participate on task forces and advisory boards
12. Among all the activities and initiatives that your project undertakes, please briefly describe the two that reflect work you view as “signature” activities of your project.
[open-ended]
Since October 2013, what has been the greatest challenge your project has experienced in providing services to children, youth and families?
[open-ended]
National Initiatives
Items 14 – 18 ask about work you may have done related to the national initiatives of Intervener Services, Early Identification and Referral, Technology Solutions, Family Engagement, and Literacy.
In the area of Intervener Services, are any of the following activities part of your project? For each row, select one option.
Have worked on this since October 2013 |
Have not worked on this yet, but plan to do so by completion of project |
Not part of our project |
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In the area of Early Identification and Referral, are any of the following activities part of your project? For each row, select one option.
Have worked on this since October 2013 |
Have not worked on this yet, but plan to do so by completion of project |
Not part of our project |
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In the area of Technology Solutions, are any of the following activities part of your project? For each row, select one option.
Have worked on this since October 2013 |
Have not worked on this yet, but plan to do so by completion of project |
Not part of our project |
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In the area of Family Engagement, are any of the following activities part of your project? For each row, select one option.
Have worked on this since October 2013 |
Have not worked on this yet, but plan to do so by completion of project |
Not part of our project |
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In the area of Literacy, are any of the following activities part of your project? For each row, select one option.
Have worked on this since October 2013 |
Have not worked on this yet, but plan to do so by completion of project |
Not part of our project |
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TA in the Area of Systems Capacity Building
Please check whether, during your current grant cycle, you have worked or plan to work with your SEA in any of the following areas:
Development or refinement of state policies or practices related to… |
We have worked with the SEA in this area since October 2013 |
We have not yet worked with the SEA in this area, but we plan to over the course of the project |
We have not worked with the SEA in this area and we do not plan to over the course of the project |
a. State definition of deafblind |
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b. Increasing identification of children with deafblindness |
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c. Reporting related to Child Count |
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d. Incorporating the expanded core curriculum |
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e. Intervener policies and practices |
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f. Teachers of deafblind |
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g. Early screening policies and practices |
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h. Transition planning policies and practices |
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i. Other: |
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j. Other: |
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Does anyone from your project participate on a state task force or advisory committee related to deafblindness?
Yes
No
Content of TA
Below
is a list of content areas that State Deaf-Blind Projects may cover
with their technical assistance and dissemination activities. Please
check all areas for which you offer any
type of technical assistance as it relates to deafblindness. To see
what sub-topics might be covered through these areas, you can roll
your cursor over the topic name. [Rollover
only possible in web-version; See list at end of document]
Adaptive living/Self-care skills |
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Assessment |
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Assistive technology |
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Behavioral issues and behavioral management |
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Cochlear implants |
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Collaboration among providers |
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Communication |
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Community and independent living |
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Curriculum (What to teach) |
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Deafblindness overview |
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Etiology |
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IEP/IFSP development and implementation |
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Inclusion |
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Intervener roles and competencies |
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Instructional strategies (How to teach) |
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Orientation and Mobility (O&M) |
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Parent/family support |
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Socialization, leisure and recreation |
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State and local policies |
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Teachers’ roles, credentialing and competencies |
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Transition (early childhood) |
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Transition (secondary) |
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Visual and tactile accommodations to sign language |
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From among the areas you checked in the previous question, what are the five topic areas for which your project receives the greatest demand for TA? Check only five. [Respondent will only see the areas checked in previous question]
Adaptive living/Self-care skills |
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Assessment |
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Assistive technology |
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Behavioral issues and behavioral management |
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Cochlear implants |
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Collaboration among providers |
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Communication |
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Community and independent living |
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Curriculum (What to teach) |
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Deafblindness overview |
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Etiology |
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IEP/IFSP development and implementation |
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Inclusion |
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Intervener roles and competencies |
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Instructional strategies (How to teach) |
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Orientation and Mobility (O&M) |
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Parent/family support |
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Socialization, leisure and recreation |
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State and local policies |
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Teachers’ roles, credentialing and competencies |
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Transition (early childhood) |
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Transition (secondary) |
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Visual and tactile accommodations to sign language |
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Collaboration
We are looking at two types of collaboration: 1) How projects assist one another, and 2) How projects collaborate within and outside their state with entities other than state projects.
The matrix that appears on the next screen lists all the State Deaf-blind Projects funded in October 2013. To complete the matrix, you will indicate which other state projects you and your staff work with or use for various purposes. Please consult staff from your project if their input is needed to complete the matrix accurately.
The columns in the matrix are not intended to represent a hierarchy, nor are the columns mutually exclusive. Instead, they simply represent some of the types of interactions that occur in a network of TA providers. Please check all appropriate boxes in each row, leaving blank the row for your own state or for any state with which you have had no significant interaction. Specifically, please check the appropriate boxes in the matrix if staff from your project worked with or used another state project to do any of the following since October 2013:
Obtained information, materials, or services, excluding training
Examples:
Your staff downloaded information or materials from the website of another state project on assisting parents with IEPs, and used them (or adapted them for use) in your state.
You requested and received an example of a needs assessment form that was used in another state.
Received training (in-person or using technology) from another state project
Examples:
Your staff received an inservice training on the use of the distance mentorship model being used in another state
Staff from your state participated in a webinar by a well-known expert that was hosted and paid for by another state project.
Your
state used an online training module in early identification
developed by another project
Created or provided a product, program, or service that required joint planning, shared decision making, or pooling of monetary or staff resources
Examples:
Your state worked with another state to provide intervener training to providers in both states.
Your state worked with another state to create a joint website to disseminate information.
Your state and five other states identified notable speakers and arranged for conferences in several of the states as a “speaker circuit.”
Please check all appropriate boxes if, since the start of your grant in October 2013, staff from your project have worked with or used the State Deaf-Blind project listed on the left to do any of the following activities.
State Deaf-Blind project |
Obtained information, materials or services (excluding training) |
Received training (in-person or using technology) from another state project |
Created or provided a product, program, or service that required joint planning, shared decision making, or pooling of monetary or staff resources |
Alabama |
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Alaska |
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Arizona |
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Arkansas |
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California |
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Colorado |
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Connecticut |
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Delaware |
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District of Columbia |
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Florida |
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Georgia |
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Hawaii |
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Idaho |
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Illinois |
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Indiana |
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Iowa |
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Kansas |
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Kentucky |
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Louisiana |
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Maine |
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Maryland |
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Massachusetts |
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Michigan |
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Minnesota |
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Mississippi |
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Missouri |
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Montana |
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Nebraska |
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Nevada |
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New Hampshire |
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New Jersey |
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New Mexico |
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New York |
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North Carolina |
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North Dakota |
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Ohio |
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Oklahoma |
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Oregon |
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Pennsylvania |
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Puerto Rico |
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Rhode Island |
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South Carolina |
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South Dakota |
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Tennessee |
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Texas |
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Utah |
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Vermont |
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Virginia |
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Washington |
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West Virginia |
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Wisconsin |
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Wyoming |
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Is
your state project part of any formal group or consortium with other
states?
O Yes
O No Skips to collaboration with other projects (Question 34)
[If yes] What is the name of that group? If your project is part of more than one group or consortium with other states, for this and the next three questions, please provide information for one of the groups. Starting with Question 29, you will be able to provide information for one additional group.
[If yes] Who are the other members?
What is the focus or topic of that group?
Is
there a Memorandum of Understanding for that group?
Yes
No
Does
your state project belong to any other formal groups or consortiums?
Please provide information for one of these other groups or
consortiums in the next four questions.
O Yes
O No Skips to collaboration with other projects (Question 34)
[If yes] What is the name of that group?
[If yes] Who are the other members?
What is the focus or topic of that group?
Is
there a Memorandum of Understanding for that group?
O Yes
O No
Since the start of your current project (or based on your plans), have you collaborated with any of the following? By “collaborated” we mean worked together on a common activity or goal. For the purpose of this question, receiving information from or providing information without any shared activity or goal does not constitute collaboration.
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Have collaborated with since October 2013 |
Have not yet collaborated, but plan to work with over the course of the project |
Have not collaborated and do not plan to work with over the course of the project |
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Instructions for Submitting Survey
Thank You & Contact Information
Thank
you for taking the time to respond to these questions. Your input is
extremely important and will be used to improve opportunities to
receive support for those who work with children and youth with
deafblindness.
Please take a minute to indicate who completed the survey, so we can follow up as needed. List the people involved in completing the survey. If there was more than one person, please indicate the person who had the greatest role in answering questions.
When
you click Save & Continue, you will see any questions that
you have left unanswered. You will have the opportunity to answer
these questions and then submit your survey.
If you have any questions, please feel free to contact us at [email protected] or toll-free at 1-800-xxx-xxxx. Thank you again for your time and effort in completing this survey!
First Name |
Last Name |
Greatest role? |
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Submit |
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Return to Survey |
FINAL SCREEN
Thank you!
Your survey data have been submitted. We appreciate your taking the time to provide us with this important information.
Please print and keep a copy of this survey for your records using the link provided below.
Print completed survey
If you have any questions, please contact us at [email protected] or toll-free at 1-800-xxx-xxxx.
TA Topics
[The information in the second column will be visible when a respondent scrolls over the topic area]
Topic |
Areas of TA May Include… |
Adaptive living/Self-care skills |
Personal care and self-help skills such as toileting, dressing, eating, and cooking |
Assessment |
Using assessment strategies for program planning for a student; vision, auditory/hearing, cognitive, communication, functional, educational, developmental or other assessment |
Assistive technology |
Technology to maximize sensory input; learning how to use devices; switches for toys and daily living, computer access; assistive listening devices (hearing aids, FM systems), low vision devices |
Behavioral issues and behavioral management |
Behavioral issues, behavior management; help in identifying why the child/student engages in problem behaviors; functional behavioral analysis and positive behavior support |
Cochlear implants |
Eligibility questions related to cochlear implants; adapting Auditory Verbal Therapy; maintenance and use of the device |
Collaboration among providers |
Teaming skills and transdisciplinary teams; collaborative teaming, transdisciplinary teams; conveying effective strategies to new teachers/new settings |
Communication |
Communication system development (e.g., object use, tactile symbols, Braille, gesture); building relationships with the student; developing and extending conversations |
Community and independent living |
Strategies to improve community and independent living skills; self-determination |
Curriculum (What to teach) |
What to teach and target; ideas for teaching meaningful skills for the student’s age; teaching skills in the natural environment/setting |
Deafblindness overview |
Overview of deaf-blindness, vision and hearing loss, gaining more information about a child’s diagnosed condition |
Etiology |
Usher Syndrome; CHARGE Syndrome; prematurity; impact of etiology on learning and interacting |
IEP/IFSP development and implementation |
Developing an appropriate IEP/IFSP for a student with combined vision and hearing loss; person-centered planning |
Inclusion |
Appropriate adaptations for inclusive education; accessing general education curriculum; targeting appropriate skills for inclusive education; effective strategies for teaching in inclusive settings |
Intervener roles and competencies |
(Interveners are people who have specialized training in deafblindness to work consistently and one-to-one with a child who is deafblind). Topics could include the role of the intervener; Council for Exceptional Children competencies for interveners |
Instructional strategies (How to teach) |
How to use visual cues or auditory cues; hand-under-hand; physical assistance with children/students who have multiple disabilities; documenting child/student progress and modifying instruction accordingly; literacy mode determination (use of Braille, large print, etc.); organizing a daily routine (sequence of activities, transition from one activity to another) |
Orientation and Mobility (O&M) |
Instruction on helping a student locating himself in his environment and using environmental information; travel and navigation independence for any age |
Parent/family support |
Connecting parents to other parents; increasing collaboration between family and school personnel; parent advocacy and leadership; sibling issues; wills, trusts and benefits; respite care |
Socialization, leisure and recreation |
Recreation and leisure skills, social-emotional concerns (relationships with others); friendship facilitation |
State and local policies |
Alternate assessment; Common Core standards |
Teachers’ roles, credentialing and competencies |
Developing credentialing plans; defining the role of the teacher of deafblind students; keeping teachers up to date; Council for Exceptional Children competencies for teachers of deafblind students; professional activities for continuing ed |
Transition (early childhood) |
Transition from early intervention to preschool; from preschool program to kindergarten program |
Transition (secondary) |
Transition from school to adult services, including college, work, rehabilitation, group homes, vocational training/employment |
Visual and tactile accommodations to sign language |
Assessing the students’ need for accommodations; training staff in specific strategies (tactile, signing, coactive signing) |
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
Author | Meredith Bachman |
File Modified | 0000-00-00 |
File Created | 2021-01-27 |