KK Student Program Fidelity 8th Grade Session 4

Form Approved

OMB No. 0920-XXXX

Exp. Date:

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Attachment KK:

Student Program Fidelity 8th Grade Session 4 (Comprehensive)

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

Student Curriculum – 8th Grade, Session 4 – How To Help Friends

Attendance Log

Implementer Name: _________________________ Implementer ID: ___________________

School ID: ____________________________ Session ID: _________________

Classroom ID:_____________________________ Program Year: ____________________

Please have each student sign initials next to their name to indicate attendance to the session

Student Names (Pre-Typed)	Student ID (pre-typed)	Student Initials for Present

S tudent Curriculum – 8th Grade, Session 4 – How To Help Friends

Implementer Name: _____________________ Implementer ID: ___________________

School ID: ____________________________ Session ID: _________________

Classroom ID:_________________________

Program Year: ____________________ Time lesson began: ___________

Date: __________________________ Time lesson ended: ___________

Please indicate if you completed the following activities:

Activity	Yes	Yes w/ changes	No
Completed the “I want to stay” “I want to leave” exercise			
Pointed out that abusive relationships are very complicated			
Pointed out that to be helpful to a friend in an abusive relationship it is important to understand a friend’s fears about getting help			
Discussed why it may be difficult to get help			
Reviewed the “Friends Wheel”			
Pointed out that teens are more likely to tell friends than an adult or professional			
Encouraged friends to connect friends in abusive relationships with professional adults			
Gave students a handout with the names of people at the school and in the community who are trained to help			
Described other people in the community who are trained to help with abusive relationships			
Described and give handouts about the crisis line, support groups, and community resources			
Encouraged students in abusive relationships to talk to someone			
Concluded session	q	q	q

Describe any changes you made to the session activities (please identify which activity you are describing by number).

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	
I was uncomfortable discussing some of the topics	
Students were uncomfortable discussing some of the topics	
Some part of the session was difficult for students (e.g., role plays, reading aloud, worksheets)	
Classroom behavior management issues	
Other more pressing classroom demands	
Other – please specify____________________________________	

Please check the extent to which the students were engaged in today’s lesson on the following measures:

Most students…	Strongly Agree	Agree	Don’t Know	Disagree	Strongly Disagree
Asked relevant questions.					
Suggested solutions to scenario problems.					
Responded correctly to questions.					
Distracted other students.					
Participated extensively in discussions.					
Discouraged other students from participating.					

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 well do you think the students understood the session material?

1  Not at all

2  A little

3  A lot

4  Completely

2. 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