Form 1 One-Year Trainee Survey form

Dear _______,

Last year you attended a 4-day MCH Epidemiology training course in <<insert location; changes annually>> that was sponsored by the Maternal and Child Health Bureau in partnership with CityMatCH and the Centers for Disease and Control and Prevention. This training included the following topics <<topics can change from year to year based on feedback, emerging issues/needs, etc>>:

• needs assessment and prioritization methods

• program evaluation

• descriptive and multivariable modeling

• analytic methods for performance measurement

• trend analysis

• absolute and relative measures of association

• effective data translation and reporting

Training methods included webinars, in-person lectures, group exercises, and opportunities for individual technical assistance both during and after the in-person courses. As part of our ongoing evaluation efforts, we are writing to you now to find out whether you have been able to apply the skills you acquired or enhanced at the training in your professional role. Your responses to these 5 brief questions will help us evaluate the impact of this training and opportunities to improve effectiveness.

Thank you in advance for your response,

<<Grantee signature>>

One-year Trainee Survey (SurveyMonkey)

1. What is your current employment?

   1. working for a state or local agency

   2. working in a capacity that supports state and local programs from a university or federal position

   3. not working in a position that directly supports public MCH programs

   4. other, please specify

2. Did you seek follow-up technical assistance from any of the faculty members after the in-person course (faculty members included Drs. Deb Rosenberg, Kristin Rankin, Bill Sappenfield, Pat O’Campo, Ashley Hirai (Schempf), and Laurin Kasehagen)? <<faculty members may change>>

   1. If Yes, what topics did you request consultation or assistance with?

   2. Were you satisfied with this technical assistance? Yes/No

   3. If not, why not?

3. List two skills you acquired or strengthened, and sustained from this training?

4. How frequently have you been able to use or apply the skills you acquired / strengthened from this training in your job?

   1. Very often

   2. Somewhat often

   3. Occasionally

   4. Rarely

   5. Not at all

5. If you have been able to use or apply skills from the training, please give up to three examples of projects and/or products (e.g., presentations, publications, program changes) that were undertaken or improved as a result of the skill enhancement.

If you have not used or applied skills from the training at all, what were the challenges or barriers that prevented you from applying the training material?

OMB Number (0915-0212) and Expiration date (7/31/2015)

Public Burden Statement:  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.  The OMB control number for this project is 0915-0212.  Public reporting burden for this collection of information is estimated to average 15 minutes per response, including the time for reviewing instructions, searching existing data sources, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to HRSA Reports Clearance Officer, 5600 Fishers Lane, Room 10C-03I, Rockville, Maryland, 20857.