Program Facilitators- Fidelity log

Components Study of REAL Essentials

Instrument 4_Fidelity Log832021

Program Facilitators- Fidelity log

OMB: 0990-0480

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INSTRUMENT 4
 
FIDELITY LOG

OMB Control No: 0990-new

Expiration Date: XX/XX/XXXX


Fidelity Log



Shape1

Table 1. Overview and attendance

Facilitator name

[Pre-programmed]

Organization or school name

[Pre-programmed]

Date

[Select]

Period or block when programming was delivered

Drop down [select one]

Class session # you completed

Drop down [select one from pre-specified/planned scope and sequence]

Deselect any students who were not present in the session

Deselect from pre-programmed list of consented students who were not present in the session

Were you wearing a mask when implementing?

Drop down [select one – yes/no]

Approximately what percentage of youth were wearing a mask?

Drop down [select one – in deciles]

Did you implement remotely?

Drop down [select one] – yes/no

Approximately what percentage of youth were attending remotely?

Drop down [select one – in deciles]



THE PAPERWORK REDUCTION ACT OF 1995

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0990-new. The time required to complete this information collection is estimated to average 10 minutes per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you have comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: U.S. Department of Health & Human Services, OS/OCIO/PRA, 200 Independence Ave., S.W., Suite 336-E, Washington D.C. 20201, Attention: PRA Reports Clearance Officer



Instructions: Please complete the following questions for each of the REA lesson(s) you expected to complete in today’s session.

Shape2

Table 2. Fidelity

REA lesson [lesson number]: [lesson name]

Indicate whether the lesson was fully completed, completed with changes, or not completed

[Dropdown- Select one]

If completed with changes, describe the changes made and why.

Note that changes might include changing the names in a role play, adding new content or activities, using other materials, or changing the way you teach something (e.g., making something into a game or using pairs instead of small groups for an activity)

[Open response]

Method(s) used

[Dropdown- Select all that apply]

Material(s) used

[Dropdown- Select one]

Describe any materials you used that were not provided or indicated in the curriculum
[Open response]

How prepared did you feel to deliver the lesson?

[Dropdown- Select one]

Indicate amount of time (in minutes) spent on the lesson?

[Open response]

Please note any factors that affected the lesson

[Dropdown-Select all that apply]

Did you use any of the following tools to complete the lesson?

[Dropdown- Select all that apply]

If this session included more than one lesson, to what extent did you use transitions connecting content across lessons?

[Dropdown-Select one]

Response options

Fully completed

Completed with changes

Not completed


Independent activity

Small-group activity

Small-group discussion

Class discussion

Class activity

Lecture or presentation

Homework assignment

Video

Role play

Game

Other

Debrief

Used only materials provided or indicated in the curriculum

Used materials provided or indicated in the curriculum as well as other materials not in the curriculum

Used only other materials not part of the curriculum


Highly prepared

Somewhat prepared

Not prepared at all


Lack of time

Disruptions caused by school issues (e.g., changes in bell schedules, student activities, etc.)

Disruptions caused by challenges with students in the class (e.g., behavioral issues, etc.)

Lack of communication with teacher or administrators

Lack of adequate space

Other, please describe: [open-ended response]

Educator note

Make an impact

Character spotlight

Connect at home

All of the above

Always

Sometimes

Never

Introduction and review of lesson/ activity objectives











[Lesson]











Takeaways, best practices, and questions to consider (from REA certification handbook)














Shape3

Table 3. Student engagement and classroom climate


On a scale of 1 to 5, how engaged were the students in the lesson? [Dropdown - Select one]

Please select any strategies you used to engage students in the lesson
[Dropdown - Select all that apply]

Did you have a co-facilitator? [Dropdown -Select one]

What was the role of the classroom teacher for the lesson? [Dropdown -Select one]

How well did the material covered match the level of students' maturity?
[Dropdown - Select one]

Response options

1- Students appear consistently inattentive, distracted, uninterested, apathetic, and/or uncooperative during this activity

2-

3- Students’ levels of interest, attentiveness, or cooperation vary during the activity; students are somewhat attentive and generally cooperative but do not ask questions, have trouble listening and responding to the facilitator, or are easily distracted; some students are using cell phones, reading, talking, etc.

4-

5- Students appear consistently interested in the activity, ask questions, respond to facilitator’s questions and directions; students are not using their cell phones, talking, passing notes, or reading

Used student names to call on them or to engage them

Used demonstrations or examples to illustrate content

Used incentives (including raffles, incentive charts, etc.)

Used icebreakers at the beginning of the lesson

Used strategies to increase energy levels

Asked open-ended questions

Asked students to pair and share

Asked students to lead activities

Circulated in the room

Other, please describe: [open-ended response]

Yes

No

Not present

Present but only observing

Present and managing students/timing

Present and actively helping to facilitate

Other: please describe.

Very well

Somewhat well

Not well at all

Introduction and review of lesson/activity objectives






[Lesson]






Takeaways, best practices, and questions to consider (from REA certification handbook)










Wrap-up and notes: Overall, on a scale from 1 to 10 (with 10 being extremely satisfied and 1 being extremely unsatisfied): How satisfied were you with the implementation of today’s lesson(s)? [Select a rating from 1 to 10]







Please use this field to add any notes about the session overall.




File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorJennifer Walzer
File Modified0000-00-00
File Created2022-01-14

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