Q Parent Program Fidelity 6th Grade Session 6

Form Approved

OMB No. 0920-XXXX

Exp. Date:

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Attachment Q:

Parent Program Fidelity 6th Grade Session 6

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

Parent Curriculum – 6th Grade, Session 6 – Moving Forward

Attendance Log

Implementer Name: _____________________ Implementer ID: ___________________

School ID: _____________________________ Session ID: _______________________

Parent / Guardian Names	Name of Child in Program	Name of Child in Program

Parent Curriculum – 6th Grade, Session 6 – Moving Forward

Session Log

Implementer Name: _____________________ Implementer ID: ___________________

School ID: _____________________________ Session ID: _______________________

Please indicate if you completed the following activities:

Activity	Yes	Yes w/ changes	No
Welcomed parents and children to the session			
Oriented children to the room and session			
Reviewed ground rules			
Facilitated review of session 5 using talking points			
Discussed how parents can assist their children in developing healthy relationships			
Reviewed homework assignment using talking points			
Discussed posters 15-17 and their relevance to talking to Children about sexual issues, the importance of values and how decisions made now affect the future			
Facilitated parent participation for parent-child discussion			
Reviewed characteristics of good communication skills using slides 2-5, Effective Parent-Child Communication			
Facilitated parent-child discussion using questions and tips provided			
Escorted children back to their room			
Facilitated discussion with parents only			
Facilitated discussion on peer pressure using slides 6-7, 4-Step Parent Plan for Peer Pressure			
Facilitated peer pressure role play			
Showed Video 15, The Pressure Teens Face			
Facilitated parent-child discussion of video 15			
Summarized information covered over past 6 sessions			
Facilitated discussion using slides 8-20			
Ended program with celebration			

Please indicate if you experienced any of these challenges that interfered with implementing today’s session.  Check all that apply.

Not enough time	
I did not have the needed materials	
Parents did not appear to understand the session	
I was uncomfortable discussing some of the topics	
Parents were uncomfortable discussing some of the topics	
Some part of the session was difficult for parents (i.e., role plays, discussing sexual issues and topics, completing homework)	
Other more pressing session demands	
Other – please specify____________________________________	

Describe any changes you made to the session activities.

Please think about today’s session and tell us your answers to the following questions. Circle the number that shows your opinion about each question.

1. How engaged were the parents in the session?

1 very bored

2

3 average

4

5 fully engaged

2. Please think about how well you think the session went today.

1 extremely poorly

2

3 average

4

5 exceptional

3. How well do you think the parents understood the session material?

1  Not at all

2  A little

3  A lot

4  Completely

4. How well did the session material fit into the allotted time period?

1 Session was too packed/not enough time to complete all activities

2 Session was somewhat packed/able to complete most but not all

3 Session was just right

4 Not enough material/session ended before class period completed

Please think about the overall implementation of the program and tell us your answers to the following questions.

How much time (excluding travel time) did you spend on parent facilitation for this session?

How much travel time and mileage did you spend on parent facilitation for this session?

What is your annual salary? Please circle the answer from the selection choices below.

1. $0 to $9,999

2. $10,000 to $19,999

3. $20,000 to $29,999

4. $30,000 to $39,999

5. $40,000 to $49,999

6. $50,000 to $59,999

7. $60,000 to $69,999

8. $70,000 to $79,999

9. $80,000 to $89,999

10. $90,000 to $99,999

11. $100,000 or above

What is a parent’s time spent on program training for this session?