GenIC Request Template form

Request for Approval under the “Generic Clearance for the Collection of Routine Customer Feedback” (OMB Control Number: 0920-1009)

TITLE OF INFORMATION COLLECTION:

Preventing Adverse Childhood Experiences Pediatric Medical Provider Module Online Course –Evaluation Questions - Course Specific

PURPOSE:

Adverse childhood experiences (ACEs) are potentially traumatic experiences, which occur in childhood. Early adverse experiences like abuse, neglect, or economic hardship can impede the progress of a strong foundation in childhood, which affects brain architecture and optimal development. ACEs have been linked to health risk behaviors, chronic health conditions, low life potential, and early death. As the number of ACEs increases, so does the risk for these outcomes. Exposure to ACEs can also limit life opportunities, including educational attainment and employment, which have far-reaching impacts beyond a single time-period, person, or generation.

It is important that more people learn about the impact of ACEs and the potential for prevention, unfortunately, no online resources existed where pediatric medical providers, mental health providers, and other health practitioners could be directed on how they could take action to prevent ACEs before they occur. Moreover resources were lacking that directed these audiences to the connection between ACEs and medical, social, and public health problems.

By developing an on-line training available on VetoViolence (https://vetoviolence.cdc.gov/) we can increase awareness of ACEs and help these audiences learn about how these problems can affect people throughout their lives and across generations.

DVP’s ACEs team collaborated with staff on DVP’s Communications team in partnership with Communications Contractor, Banyan to develop an online training for pediatric medical providers. The modules contain innovative videos with compelling graphics and images to teach concepts, which are interspersed with interviews of subject matter experts explaining ideas with examples and engaging stories. The modules contain a total of 12 videos, and 9 skill checks, which correspond the various sections within the module and test the user on the content they reviewed.

CDC’s Training and Continuing Education Office (TCEO) reviewed all materials and facilitated the course’s accreditation for continuing education including Continuing Nursing Education (CNE), IACET Continuing Education Units (CEU), Certified Health Education Specialists (CHES) continuing education contact hours and Certified in Public Health recertification credits. Part of the accreditation process from TCEO requires course-specific evaluation questions to receive Paper Reduction Act (PRA) approval. These course-specific questions will be incorporated to the standard course evaluation survey developed and implemented by TCEO (OMB# 0920-0017).

The purpose of this request is to gather timely feedback from online course participants on the delivery of the web-based Prevention Adverse Childhood Experiences Pediatric Medical Provider Module Online Course and add 9 additional questions to those already in TCEO’s system that are specific to the training. The information collected will allow CDC to identify areas of improvement for this course and other ACEs- prevention related training efforts. It will also help ensure CDC is providing efficient and effective information delivery. Feedback is vital to ensure trainings are beneficial for participants.

Information gathered will be used only internally for general online course and information dissemination improvement and is not intended for release beyond CDC. Information gathered will not be used for the purpose of substantially informing influential policy decisions. Without these types of feedback, the Agency will not have timely information to adjust its online course to meet customer needs.

DESCRIPTION OF RESPONDENTS:

Respondents are individuals who voluntarily completed the Preventing Adverse Childhood Experiences Pediatric Medical Provider Online Course and have requested continuing education via CDC TCEO. The collection is targeted to the solicitation of opinions from respondents who serve children and families and are interested in learning how to prevent adverse childhood experiences. Participants can include pediatricians, physician assistants, pediatric nurses and other health care providers that work closely in the pediatric setting.

TYPE OF COLLECTION: (Check one)

[ ] Customer Comment Card/Complaint Form [X] Customer Satisfaction Survey

[ ] Usability Testing (e.g., Website or Software [ ] Small Discussion Group

[ ] Focus Group [ ] Other: ______________________

CERTIFICATION:

I certify the following to be true:

1. The collection is voluntary.

2. The collection is low-burden for respondents and low-cost for the Federal Government.

3. The collection is non-controversial and does not raise issues of concern to other federal agencies.

4. The results are not intended to be disseminated to the public.

5. Information gathered will not be used for the purpose of substantially informing influential policy decisions.

6. The collection is targeted to the solicitation of opinions from respondents who have experience with the program or may have experience with the program in the future.

Name:___________Karen Angel_____________________________________

To assist review, please provide answers to the following question:

Personally Identifiable Information:

1. Is personally identifiable information (PII) collected? [ ] Yes [X ] No

2. If Yes, is the information that will be collected included in records that are subject to the Privacy Act of 1974? [ ] Yes [X ] No

3. If Applicable, has a System or Records Notice been published? [ ] Yes [X ] No

Privacy Act does not apply for this information collection request. (Att 2). Personal Private Information is not collected. All procedures have been developed, in accordance with federal, state and local guidelines, to ensure that the rights and privacy of respondents will be protected and maintained.

Gifts or Payments:

Is an incentive (e.g., money or reimbursement of expenses, token of appreciation) provided to participants? [ ] Yes [X ] No

BURDEN HOURS

The target respondents will be participants who complete the Preventing Adverse Childhood Experiences Pediatric Medical Provider Module Online Course and request continuing education via TCEO. This web-based course is available free of charge for anyone interested, to complete at their preferred day/time. Approximately, 4,500 participants are expected to complete the online course.

Category of Respondent	No. of Respondents	Participation Time	Burden
Course Specific Evaluation Questions (Att. A)	4,500	3/60	225
Totals			225

FEDERAL COST: The estimated annual cost to the Federal government is $2,000.

If you are conducting a focus group, survey, or plan to employ statistical methods, please provide answers to the following questions:

The selection of your targeted respondents

1. Do you have a customer list or something similar that defines the universe of potential respondents and do you have a sampling plan for selecting from this universe? [ ] Yes [X ] No

If the answer is yes, please provide a description of both below (or attach the sampling plan)? If the answer is no, please provide a description of how you plan to identify your potential group of respondents and how you will select them?

Participants are individuals who voluntarily choose to take the Preventing Adverse Childhood Experiences Pediatric Medical Provider Module Online Course, and request continuing education for completing it via CDC TCEO. No sampling will be conducted.

Upon logging in to TCEO to request continuing education for completing the online course, TCEO will follow their standard processes to provide the online course evaluation form for participants to complete. The Course Specific Evaluation Questions (Att. A) will be incorporated to TCEO’s standard course evaluation form.

The Course Specific Evaluation Questions consist of 9 questions, all of which are closed-ended. Questions ask about the participants’ satisfaction with the training content, delivery and impact/benefit for their adverse childhood experiences prevention efforts; no personally identifiable information will be collected. The Course Specific Evaluation Questions take an average of three minutes to complete. There will be no direct costs to the respondents other than their time to respond to the survey.

Administration of the Instrument

1. How will you collect the information? (Check all that apply)

[ X ] Web-based or other forms of Social Media

[ ] Telephone

[ ] In-person

[ ] Mail

[ ] Other, Explain

2. Will interviewers or facilitators be used? [ ] Yes [X ] No

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