Self-Regulation Training Approaches and Resources to Improve Staff Capacity for Implementing Healthy Marriage Services for Youth (SARHM)

INSTRUMENT 3: session assessment form MATHEMATICA POLICY RESEARCH

Staff ID# ____________________

Thank you for participating in the road test of Self-Regulation Approaches and Resources in Healthy Marriage programs (SARHM). The purpose of this information collection is to learn about your experience using the co-regulation strategies you were trained to implement during [reporting period]. Participation in this information collection is voluntary. The estimated time to complete this form is 10 minutes. Your responses will be kept private to the extent permitted by law. Please do not include any personal information, such as your name or contact information, on this form.

Section 1: Use of co-regulation strategies

1. How many group workshops did you deliver during [reporting period]?

_________ GROUP WORKSHOPS

2. How many client meetings did you have during [reporting period]?

_________ CLIENT MEETINGS

3. Did you use co-regulation strategies in at least one group workshop or client meeting during [reporting period]?

1 □ Yes GO TO Q5

0 □ No

4. You responded that you didn’t use any of the strategies. Why?

GO TO END

Paperwork Reduction Act Statement - This information collection meets the requirements of 44 U.S.C. § 3507, as amended by section 2 of the Paperwork Reduction Act of 1995. You do not need to answer these questions unless we display a valid Office of Management and Budget control number. The OMB control number for this information collection is 0970-0355, expiring 5/31/2021. We estimate that it will take 10 minutes to read the instructions and answer the questions.

5. Did you use the following co-regulation strategies during [reporting period]?

CO-REGULATION STRATEGIES	A			B
	GROUP WORKSHOPS			CLIENT MEETINGS
	SELECT ONE RESPONSE PER ROW			SELECT ONE RESPONSE PER ROW
	NOT AT ALL	A LITTLE	A LOT	NOT AT ALL	A LITTLE	A LOT
a. Positive Note Home	1 □	2 □	3 □	1 □	2 □	3 □
b. Positive Verbal/Written Praise by educator or “Tootles” between Peers	1 □	2 □	3 □	1 □	2 □	3 □
c. Mystery Motivator/Token Lottery	1 □	2 □	3 □	1 □	2 □	3 □
d. Team Competition	1 □	2 □	3 □	1 □	2 □	3 □
e. Nasal or Timed Breathing	1 □	2 □	3 □	1 □	2 □	3 □
f. Participation-based grade	1 □	2 □	3 □	1 □	2 □	3 □
g. Mindfulness Exercises	1 □	2 □	3 □	1 □	2 □	3 □
h. Bookending	1 □	2 □	3 □	1 □	2 □	3 □
i. Teach, Practice, Plan, Reflect, Reward	1 □	2 □	3 □	1 □	2 □	3 □
j. Tag it, Tell it, Tune it	1 □	2 □	3 □	1 □	2 □	3 □
k. Group Norms + Personal Commitment	1 □	2 □	3 □	1 □	2 □	3 □
l. Room Set-Up	1 □	2 □	3 □	1 □	2 □	3 □
m. Interaction Tally	1 □	2 □	3 □	1 □	2 □	3 □
n. Rest and Return	1 □	2 □	3 □	1 □	2 □	3 □
o. F.U.N. (Following the rules, room set Up, No negatives)	1 □	2 □	3 □	1 □	2 □	3 □
p. Welcome Strategies	1 □	2 □	3 □	1 □	2 □	3 □
q. Intentional Use of EBKs for Relationship-building	1 □	2 □	3 □	1 □	2 □	3 □
r. Motivation/Interest Assessment	1 □	2 □	3 □	1 □	2 □	3 □
s. Peer Makeups	1 □	2 □	3 □	1 □	2 □	3 □

6. Of the co-regulation strategies you used, did any work particularly well? Why?

7. Of the co-regulation strategies you used, did any not work well? Why?

Section 2: Interactions with youth

8. Think about the ways you interacted with youth during [reporting period] when you used the specific co-regulation strategies. Indicate the extent to which you agree/disagree with the following statements.

	SELECT ONE RESPONSE PER ROW
	Strongly agree	Agree	Disagree	Strongly disagree
a. I displayed a warm, positive attitude	1 □	2 □	3 □	4 □
b. I remained calm and focused during our interaction	1 □	2 □	3 □	4 □
c. I provided support in times of stress or intense emotion	1 □	2 □	3 □	4 □
d. I created a physically and emotionally safe environment	1 □	2 □	3 □	4 □
e. I set expectations that were developmentally appropriate	1 □	2 □	3 □	4 □
f. I modeled or shared my experience using self-regulation skills	1 □	2 □	3 □	4 □
g. I provided opportunities for youth to practice self-regulation skills	1 □	2 □	3 □	4 □
h. I reinforced positive self-regulation behaviors	1 □	2 □	3 □	4 □

Section 3: Overall reflections

9. How comfortable did you feel using the strategies during the reporting period?

MARK ONE ONLY

1 □ Very comfortable

2 □ Somewhat comfortable

3 □ Mostly comfortable

4 □ Very comfortable

10. Overall, which of the following best describes youth’s response to the co-regulation strategies?

MARK ONE ONLY

1 □ Very responsive

2 □ Mostly responsive

3 □ Somewhat responsive

4 □ Very unresponsive

11. Are there any other comments you would like to share?

Thank you for completing this form!

Prepared by Mathematica Policy Research 7