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

Formative Data Collections for ACF Program Support

SARHM Youth Focus Group-Instrument 2_2020-2-14-clean

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

OMB: 0970-0531

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SARHM Instrument 2 OMB #: 0970-0351

Mathematica Expiration Date: 7/31/2022

Instrument 2: Responding to the scenario (worksheet)

In the moment…

Sensations I notice in my body



Thoughts coming through my head


Words that describe my feelings and emotions in the moment


How do I want to respond to these sensations, thoughts, and feelings?


My immediate response…

What is most important to me to make happen? What goal do I have in this situation?


Responses that will probably help these things to happen


Responses that could harm what I care about


Things I could do in the moment to help myself act in a way to make the situation better or feel better


After some time passes…

How do I respond when I’ve had some time to settle down?


How do I handle the situation to get back on track with my goal or prioritize what’s really important to me?




The Paperwork Reduction Act Statement: This collection of information is voluntary and will be used to inform the language and messages that ACF uses for future trainings and training materials about self- and co-regulation for ACF-funded HMRE programs.. Information provided in this collection will be kept private. The estimate time to complete this collection, including the related focus group is 90 minutes, including the time to review instructions and complete and review 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 Scott Baumgartner at [email protected].

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