Educator Outcome Survey (Baseline)

Attachment I:

Educator Outcome Survey Baseline

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 to average 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 Information Collection Review Office, 1600 Clifton Road NE, MS D-24, Atlanta, Georgia 30333; ATTN: PRA (0920-XXXX).

Site Number:

Program Year:

School Number:

Evaluation of CDC’s Dating Matters™:

Strategies to Promote Healthy Teen Relationships Initiative

EDUCATOR SURVEY (BASELINE)

1. What is the name of the school where you work most of your hours? _________________________

1a. Do you work at more than one school?

Yes

No

2. What is your primary role at this school?

 Full-time teacher

 Part-time teacher

 Full-time guidance counselor

 Part-time guidance counselor

 Contractor employed to teach Dating Matters or Safe Dates curriculum

 Other (specify:___________________)

3. 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

4. What is your gender?

 Male

 Female

 Transgender

5. Are you Hispanic or Latino?

 Yes

 No

6. What is your race? You may mark one or more races, as appropriate:

 White

 Black of African American

 Native Hawaiian or other Pacific Islander

 Asian

 American Indian or Alaska Native

 Other

7. Have you ever implemented a dating violence prevention curriculum?

 Yes

 No  If No, skip to Question 8

7a.Mark the groups to which you have provided a dating violence prevention curriculum.
(Check all that apply.)

 6^th, 7^th or 8^th grade students

 High school students

 Parents, to help them support their children

8. During this school year, are you scheduled to teach a teen dating violence prevention curriculum (either ‘comprehensive/ Dating Matters’ or ‘standard/Safe Dates’)?

 Yes

 No  If No, skip to Question 9

8a.Mark the groups to which you will teach a teen dating violence prevention curriculum

(either ‘comprehensive/ Dating Matters’ or ‘standard/Safe Dates’).

(Check all that apply.)

 a. Comprehensive Dating Matters for 6^th grade students

 b. Comprehensive Dating Matters for 7^th grade students

 c. Comprehensive Dating Matters for 8^th grade students

 d. Standard/Safe Dates for 8^th grade students

 e. Parents Matter! for students’ parents

9. Have you ever delivered any educational activities that addressed youth sexual harassment?

 Yes

 No  If No, skip to Question 10

9a.Mark the groups to which you have provided educational activities that addressed

youth sexual harassment. (Check all that apply.)

 6^th, 7^th or 8^th grade students

 High school students

 Parents

 Teachers

 Other school staff

10. Are you aware of any educational activities in your school that have addressed youth sexual harassment, currently or in the past year?

 Yes

 No  If No, skip to Question 11

10a. Mark the groups in your school who have received educational activities addressing youth sexual harassment. (Check all that apply.)

 6^th, 7^th or 8^th grade students

 High school students

 Parents

 Teachers

 Other school staff

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

Strongly Agree

Agree

Neutral

Disagree

Strongly Disagree

a. Teachers respect students in this school.

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b. I feel safe before and after school while on school grounds.

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c. Parents are involved in activities at school.

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d. Students use drugs or alcohol outside of school.

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e. Teachers work hard to make every student successful.

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f. Students enjoy learning here.

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g. I feel that I belong at this school.

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h. Groups of students cause problems or conflicts at school.

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i. Students feel comfortable telling a teacher or an administrator about potential violence.

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j. I have seen a gun at school this year.

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k. I feel safe in the school hallways.

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l. Most students are proud of this school.

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m. Teachers have input in decision-making at this school.

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n. Some students are regularly hassled by other students.

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o. Teachers care about student learning at this school.

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p. Teachers and administrators supervise the halls during passing time.

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q. I have seen students smoking at school or on school grounds.

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r. Teachers praise students when they have done well.

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Strongly Agree

Agree

Neutral

Disagree

Strongly Disagree

s. Arguments among students are common at school.

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t. Teachers enjoy teaching here.

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u. I have seen a knife at school (not including a cafeteria knife).

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v. Teachers listen carefully to what students have to say.

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w. Name-calling, insults, or teasing happen regularly at school.

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x. Students respect teachers in this school.

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y. Parents are made to feel welcome at this school.

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z. Students use alcohol or drugs at school.

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aa. I am proud of this school.

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ab. Students regularly cheat on tests or assignments.

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ac. Students cut classes or are absent regularly.

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ad. Overall, I feel that this school is a safe school.

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ae. I have seen students with drugs or alcohol at school.

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af. Administrators listen to what teachers have to say.

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ag. I feel safe in my classroom(s).

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ah. Robbery or theft of school property over $10 in value is common.

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ai. Students are generally treated fairly at this school.

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aj. Sale of drugs occurs on school grounds.

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ak. Students cooperate with teacher requests.

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al. Physical fighting or conflicts happen regularly at school.

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am.Most students are getting a good education at this school.

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an. Threats by one student against another are common at school.

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12. In this school, students generally think that…

Strongly Agree

Somewhat Agree

Somewhat Disagree

Strongly Disagree

a. It is ok for a boy to hit his girlfriend if she did something to make him mad.

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b. It is ok for a boy to hit his girlfriend if she insulted him in front of friends.

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c. Girls sometimes deserve to be hit by the boys they date.

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d. A girl who makes her boyfriend jealous on purpose deserves to be hit.

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e. Boys sometimes deserve to be hit by the girls they date.

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f. Sometimes boys have to hit their girlfriends to get them back under control.

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g. It is ok for a boy to hit a girl if she hit him first.

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h. It is ok for a girl to hit a boy if he hit her first.

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13. In your school, how often do you see students:

Never

Seldom

Sometimes

Often

a.

Make unwelcome sexual comments, jokes or gestures?

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b.

Call another student gay or lesbian in a negative way?

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c.

Touch another student in an unwelcome sexual way?

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d.

Show other students sexy or sexual pictures that they? don’t want to see

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e.

Physically intimidate another student in a sexual way?

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f.

Force another student to do something sexual?

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

15. Have you been trained about school protocols for action(s) to take if you witness sexual harassment between students?

 Yes

 No

16. Have you been trained about school protocols for action(s) to take if you witness teen dating violence between students?

 Yes

 No

17. Are you knowledgeable about laws and your responsibilities if you witness sexual harassment or teen dating violence between students?

 Yes

 No

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

		Big Problem	Small Problem	No Problem At All
a.	Smoking or tobacco use			
b.	Drug use			
c.	Alcohol use			
d.	Gang violence			
e.	Sexual harassment			
f.	Teen pregnancy			
g.	Vandalism/thieving			
h.	Eating disorders			
i.	Racial conflict			
j.	Dating violence			
k.	Stress or pressure			
l.	Bullying			

19. In the last 12 months, have you taken the Dating Matters online training for educators (at www.vetoviolence.org)?

 Yes

 No

20. Please indicate how strongly you agree or disagree with the following statements:

	Strongly Agree	Somewhat Agree	Somewhat Disagree	Strongly Disagree
a. I believe teen dating violence could be prevented.				
b. I see teen dating violence prevention programs and policies fitting within my school.				
c. 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.				
	Strongly Agree	Somewhat Agree	Somewhat Disagree	Strongly Disagree
d. I believe educators played an important role in teen dating violence prevention.				
e. I see the importance of adults modeling respectful relationships for youth.				
f. I plan to incorporate teen dating violence prevention into my classroom lessons.				
g. I feel comfortable discussing teen dating violence with my students.				
h. I feel confident in my ability to discuss teen dating violence with my students.				

If Question 8= Yes (have implemented or will implement DM or Safe Dates), then proceed to Question 21.

If Question 8= No (have not or will not implement DM or SD), end of survey.

21. Please rate your level of agreement with the following statements regarding the sustainability of the Dating Matters initiative (this includes programs called “Dating Matters” or “Safe Dates”).
	Strongly Agree	Somewhat Agree	Somewhat Disagree	Strongly Disagree
My school administration seems to be committed to the long-term goals of Dating Matters or Safe Dates.				
I am committed to the long-term goals of Dating Matters or Safe Dates.				
I am prepared to participate in the ongoing implementation of Dating Matters or Safe Dates.				