Form 0920-1050 2020 Reverse Site Visit Feedback Form

Attachment 1: 2020 Reverse Site Visit Feedback Form

CE18-1801: deltA (domestic violence prevention enhancement and leadership through alliances) impact

OMB Control No. 0920-1050

Exp. Date 05/31/2022

Thank you for attending the DELTA Impact 2020 Reverse Site Visit. We’re always looking for ways to continuously improve. Please take a moment to provide us with feedback about the Reverse Site Visit. The information collected will be used to identify areas of improvement for future site visits and technical assistance efforts. As attendees of the first virtual reverse site visit, your insight is particularly valuable.

This should take no more than 10 minutes to complete. Please complete this survey by August 31, 2020. All responses will be kept confidential and information will only be shared in its aggregate form.

You can edit previous responses as you complete the survey; however, you must complete the survey in one sitting or you will lose all of your responses. To return to a previous page, use the ‘Previous’ button at the bottom of the page (NOT the “Back” button on your browser menu). To advance, use the “Next” button at the bottom of the page.

If you have any questions, please contact Lindsey Barranco ([email protected]).

Public reporting burden of this collection of information is estimated to average 10 minutes per respondent. 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-74, Atlanta, Georgia, 30333; ATTN: PRA (0920-1050).

Which of the following best describes your role? SELECT ALL THAT APPLY.

☐ Coalition Program Staff

☐ Evaluator

☐ Coordinated Community Response (CCR) Team staff

☐ Other, please specify: ____________________________

Part 1: Please rate the following sessions:

Day 1:

Anti-Racist and Equity Work in IPV Primary Prevention Part One : Moving the Field Forward

Overview: This discussion focused on strategies to center racial and gender equity in the broader field of violence prevention. This session involved a facilitated discussion with the whole group followed by smaller breakout groups. Facilitator: Karen Francis, Director of Diversity and Inclusion, American Institutes for Research (AIR)

• I did not participate in this session.

	Strongly Disagree	Disagree	Agree	Strongly Agree	Don’t know/ Not Applicable
For the following questions, consider the session as whole.
The content of the session was useful to my work.
The structure of the session as a whole was appropriate for the content.
Technology was used effectively for this session.
There was enough time to discuss the topic.
For the following questions, consider the part(s) of the session with the entire group.
The facilitator demonstrated knowledge of the content.
The facilitator effectively engaged participants in the large group discussion.
The format of this portion of the session was appropriate for the content.
For the following questions, consider the part(s) of the session with the breakout group.
The facilitators effectively engaged participants in the breakout groups.
The format of the breakout group was appropriate for the content.
The prompt or activity for the breakout group was effective/useful.
I plan to apply what I learned in this session for DELTA Impact related work.

Additional Comments:

Impact Statements and Success Stories Presentation

Overview: In this session, participants learned how to write compelling and strong impact examples about their programs. Facilitators: Sam Sileno and Elizabeth Belser-Vega, CDC

• 

  Additional Comments:

  I did not participate in this session.

	Strongly Disagree	Disagree	Agree	Strongly Agree	Don’t know/ Not Applicable
The content of the session was useful to my work.
The facilitators demonstrated knowledge of the content.
The format of this session was appropriate for the content.
The presentation utilized technology effectively.
There was enough time to discuss the topic.
The facilitators effectively engaged participants.
I gained knowledge on developing impact statements.
I plan to apply what I learned in this session for DELTA Impact related work.

Communities of Practice Discussion

Overview: In this session, participants discussed common challenges across Communities of Practice and considered strategies to address barriers going forward. Facilitators: DELTA Impact Recipients

• NA, I did not participate in this session

	Strongly Disagree	Disagree	Agree	Strongly Agree	Don’t know/ NA
The content of the discussion was useful to my work.
The format of the discussion was appropriate for the content.
Technology was used effectively for this discussion.
There was enough time to discuss the topic.
The facilitators effectively engaged the participants.
I plan to apply what I learned in this session for DELTA Impact related work.

Additional Comments:

Day Two

Anti-Racist and Equity Work in IPV Primary Prevention Part Two: Working with Partners

Overview: In this session, participants discussed strategies and challenges to conduct antiracist and equity work with partner organizations. This session involved a facilitated discussion with the whole group followed by smaller breakout groups. Facilitators: NCCADV

• I did not participate in this session.

	Strongly Disagree	Disagree	Agree	Strongly Agree	Don’t know/ Not Applicable
For the following questions, consider the session as whole.
The content of the session was useful to my work.
The structure of the session as a whole was appropriate for the content.
Technology was used effectively for this session.
There was enough time to discuss the topic.
For the following questions, consider the part(s) of the session with the entire group.
The facilitator(s) effectively engaged participants in the large group discussion.
The format of this portion of the session was appropriate for the content.
For the following questions, consider the part(s) of the session with the breakout group.
The facilitators effectively engaged participants in the breakout groups.
The format of the breakout group was appropriate for the content.
The prompt or activity for the breakout group was effective/useful.
I plan to apply what I learned in this session for DELTA Impact related work.

Adaptations

Overview: This presentation focused on strategies to adapt program and policy efforts. Facilitator:

Kimberly Freire, Behavioral Scientist, CDC

• I did not participate in this session.

	Strongly Disagree	Disagree	Agree	Strongly Agree	Don’t Know/ NA
The content of the session was useful to my work.
The facilitator demonstrated knowledge of the content.
The format of this session was appropriate for the content.
The presentation utilized technology effectively.
There was enough time to discuss the topic.
The facilitator effectively engaged the participants.
I plan to apply what I learned in this session for DELTA Impact related work.

Additional Comments:

Workgroup Sessions

Which workgroup discussion did you participate in? (Select ONE)

• Evaluation Problem Solving – Facilitated by NAMES

• Prevention During the Pandemic: Messaging and Policy – Facilitated by NAMES

• Sharing with Unfunded Coalitions – Facilitated by NAMES

• NA, I did not participate in any of these discussion groups

	Strongly Disagree	Disagree	Agree	Strongly Agree	Don’t Know/ N/A
The content of the discussion was useful to my work.
The format of this discussion was appropriate for the content.
Technology was used effectively for this discussion.
There was enough time to discuss the topic.
The facilitators effectively engaged the participants.
I plan to apply what I learned in this session for DELTA Impact related work.

Additional Comments:

Day 3

Anti-Racist and Equity Work in IPV Primary Prevention Part Three: Centering the Work in Our Own Organizations

Overview: In this session, participants discussed strategies and challenges to incorporate antiracist and equity practices in their organizations’ work. This session involved a facilitated discussion with the whole group followed by smaller breakout groups. Facilitators: DELTA Impact Recipients

• I did not participate in this session.

	Strongly Disagree	Disagree	Agree	Strongly Agree	Don’t know/ Not Applicable
For the following questions, consider the session as whole.
The content of the session was useful to my work.
The structure of the session as a whole was appropriate for the content.
Technology was used effectively for this session.
There was enough time to discuss the topic.
For the following questions, consider the part(s) of the session with the entire group.
The facilitator(s) effectively engaged participants in the large group discussion.
The format of this portion of the session was appropriate for the content.
For the following questions, consider the part(s) of the session with the breakout group.
The facilitators effectively engaged participants in the breakout groups.
The format of the breakout group was appropriate for the content.
The prompt or activity for the breakout group was effective/useful.
I plan to apply what I learned in this session for DELTA Impact related work.

Additional Comments:

Workgroup Sessions

Which discussion group did you participate in? (Select ONE)

• Partnership, Expansion & Sustainability – Facilitated by NAMES

• Media Campaigns – Facilitated by NAMES

• Prevention During the Pandemic: Adapting In-Person Programming – Facilitated by NAMES

• NA, I did not participate in any of these discussion groups

Overview: This breakout session allowed participants to discuss a selected topic in a small group.

• I did not participate in this session.

	Strongly Disagree	Disagree	Agree	Strongly Agree	Don’t Know/ N/A
The content of the discussion was useful to my work.
There was enough time to discuss the topic.
The format of this discussion was appropriate for the content.
Technology was used effectively for this discussion.
The facilitators effectively engaged the participants.
I plan to apply what I learned in this session for DELTA Impact related work.

Additional Comments:

Part 2: Please respond to the following questions on the virtual site visit.

How would you rate the overall reverse site visit on:

	Poor	Fair	Good	Excellent
The content of the meeting?
The format (the order and variety of events) of the meeting?
The use of technology?
The opportunity to hear from other recipients?
The facilitation of sessions?
The level of participant engagement?
The opportunity to ask questions?
The use of time?

Comments:

What aspect of the reverse site visit did you find MOST useful?

What aspects of the reverse site visit did you find LEAST useful?

Comments:

What is one thing learned from the reverse site visit that you are planning to do by the end of this project year?

Comments:

How can virtual or in person future reverse site visits be improved?

Comments:

Comments:

What suggestions do you have for ways to better engage participants in virtual meetings and events?

What topics would you like to see addressed in future technical assistance, project calls, or meetings?

Comments: