Data Collection to Inform a Curriculum Adaptation for the Personal Responsibility Education Program (PREP): Promising Youth Programs (PYP) Project

Instrument 1: Fidelity Log

Digital Citizenship: Internet safety lessons for youth with intellectual and developmental disabilities

Online Fidelity Log

Instructions: Please complete one fidelity log per implementation session within 24-hours of facilitating the lesson. The fidelity log should only include activities completed during that session. For example, if it takes two days to deliver the content in Lesson 1: Chatting and Red Flags, you should complete two separate fidelity logs that each describe the activities and engagement for the specific implementation session.

1. Facilitator ID [pre-populated]:

2. School or organization name [pre-populated]:

3. Date:

4. Period or block when programming was delivered (if applicable):

5. Did you have a co-facilitator or classroom aide assist with delivering the lesson?

   1. Yes

   2. No, skip to the activity log (table 1)

6. If yes, what is the role of the co-facilitator in your classroom?

Table 1. Lesson 1: Chatting and Red Flags activity log

Activity	Time [in minutes spent on this lesson]	Completion [select one]	If completed with changes, describe the changes made and why; whether changes were planned or spontaneous; and how students reacted to any changes. Note: Changes might include changing the names in a scenario, 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 or small groups instead of a large group for an activity).	On a scale of 1 to 5, to what extent did students participate during this activity? [Select one]	On a scale of 1 to 5, to what extent did students understand the content and main messages from this activity? [Select one]
Response options	[open response]	Fully completed Completed with changes Partially completed Not completed	[open response]	1- Students did not listen or interact at all 2- 3- Students listened and interacted sometimes 4- 5- Students listened and interacted very well; students participated throughout the activity	1- Students did not understand any part of the activity 2- 3- Students understood about half of the content 4- 5- Students understood all the content in the activity
Lesson 1: Chatting and red flags
Pre-teach and comprehension check
Consider: Risky online relationships
Reflect: Texting scenario
Explore: Sheyna's situation
Group assessment

Table 2. Lesson 2: Rewarding Relationships activity log

Activity	Time [in minutes spent on this lesson]	Completion [select one]	If completed with changes, describe the changes made and why; whether changes were planned or spontaneous; and how students reacted to any changes. Note: Changes might include changing the names in a scenario, 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 or small groups instead of a large group for an activity).	On a scale of 1 to 5, to what extent did students participate during this activity? [Select one]	On a scale of 1 to 5, to what extent did students understand the content and main messages from this activity? [Select one]
Response options	[open response]	Fully completed Completed with changes Partially completed Not completed	[open response]	1- Students did not listen or interact at all 2- 3- Students listened and interacted sometimes 4- 5- Students listened and interacted very well; students participated throughout the activity	1- Students did not understand any part of the activity 2- 3- Students understood about half of the content 4- 5- Students understood all the content in the activity
Lesson 2: Rewarding relationships
Consider: Texting and talking
Explore: Friendships and feelings
Analyze: Flag it
Group assessment

1. Overall, on a scale from 1 to 5 (with 5 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 5]

2. Please use this field to share any notes on how the activities or slides could be adapted and/or improved to make the lesson more engaging and/or accessible for your students? [open ended]

3. Please use this field to share any notes about the facilitator instructions. For example, how they could be changed to improve instruction clarity. [open ended]

4. Please use this field to share any additional notes about session overall. For example, elaborating on positive aspects or challenges with student comprehension or engagement. [open ended]

DRAFT 05/04/22 4