Form TTA Follow up Form TTA Follow up Form TTA Follow up Form

Form Approved

OMB NO. 0930-xxxx

Exp. Date xx/xx/xxxx

Training and Technical Assistance (TTA)

GPRA Follow-up Form (GPRA-FU)

Public reporting burden for this collection of information is estimated to average 10 minutes to complete this questionnaire. Send comments regarding this burden estimate or any other aspect of this collection of information to the Substance Abuse and Mental Health Services Administration (SAMHSA) Reports Clearance Officer, Room 15E57A, 5600 Fishers Lane, Rockville, MD 20857. 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 Office of Management and Budget (OMB) control number. The control number for this project is 0930-xxxx.

Protocol for New GPRA Process

The Training and Technical Assistance programs are SAMHSA programs funded with the intent to support community and professional development. A uniform data collection tool will be used by all TTA grantees.

GPRA Follow-up Form (GPRA-FU): (aka the 60-day follow-up)

• This form will collect follow-up data for events lasting at least 3 hours (or more) in length.

• This form will collect information on application and usefulness of the information gained during the TTA event.

GPRA Follow-up Form (GPRA-FU)

Event Name: ____________________________

Please print clearly in the boxes below using blue or black ink. Print only one number or letter in each square. Uppercase letters only. Provide the last 3 digits of your personal zipcode; last 4 digits of your phone number; 2 digit birth year; first 3 letters of preferred name.

Personal Code (please use uppercase letters): Ex. 734036172BRI

Provide unique identifying instructions (12 characters)

___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___

LAST 3 ZIPCODE LAST 4 DIGITS PH NO. BIRTH YR FIRST 3 PREFERRED NAME

1. Prior to participating in this event, I felt there was a need for me, my organization, and/or my community to make a change related to the topic of the event.

Strongly Agree

Agree

Neutral

Disagree

Strongly Disagree

2. The information from this event has benefited or met a need for me, my family and/or community.

Strongly Agree

Agree

Neutral

Disagree

Strongly Disagree

3. The information from this event has benefited me professionally.

Strongly Agree

Agree

Neutral

Disagree

Strongly Disagree

4. I have used the information gained from this event to make changes in my practice or to help my family and/or my community.

Strongly Agree

Agree

Neutral

Disagree

Strongly Disagree

5. I expect to continue using the information from this event in the future.

Strongly Agree

Agree

Neutral

Disagree

Strongly Disagree

6. I have shared the information gained from this event with my family, community, or colleagues.

Yes

No

7. What about the event was most useful in supporting your work responsibilities or your role in your community? (CHECK ALL THAT APPLY)

Handouts and resources

Online resources

General information acquired

New ideas to help my community

New ideas to help my practice/patients/consumers

Networking/interaction with trainers/leaders and participants

Learning new modalities/interventions to improve life in my community

Learning new modalities/interventions to improve my practice

Learning how to be more empathic with community members or patients/consumers

Better understanding of the content of the event

Better understanding of patients/consumers’ needs

Learning the importance of making ongoing improvements to my practice

Other: ________________________________________

8. If you are a healthcare provider (professional and paraprofessional healthcare providers, including prevention, addiction and mental health treatment and recovery services from states, local, tribal, or healthcare organizations etc.), what has improved in your organization/practice because of this event? (CHECK ALL THAT APPLY)

Improved communication/interaction with patients/consumers/participants/key stakeholders

Improved communication with staff

Improved leadership/management style

Increased awareness of patients/consumers/participants/key stakeholders’ needs

Better application of culturally responsive practices

Adopted new practices/interventions

Improved implementation of existing practices/interventions

Implemented telehealth

Expanded access to underserved populations

Improved collection and/or use of assessment and/or evaluation data

Adapted programs, policies, practices, or other interventions to meet local culture

Improved community readiness and/or increased community mobilization

No change

Another _____________________________________________

9. If you are a student, how has this event impacted you? (CHECK ALL THAT APPLY)

Improved my understanding of the subject

Inspired me to learn more about the subject

Prepared me to better serve patients/consumers/participants/key stakeholders

Helped me to choose a specialty area

It did not

Other ________________________________________________

10. If you are a community member, from your observation, what has improved in your community because of this event?

Better understanding of substance use disorders and/or mental illness

Better understanding of effective behavioral health interventions

Increased implementation of prevention programs

Better communication with family or community members

Increased awareness of community members’ needs

Increased community action/group action/collective advocacy

Enhanced community dialogue or increased accessibility to support groups

Decreased stigma toward people with substance use disorders or mental illness

Collective sense of wellbeing

No change

Other ______________________________________

Open-ended questions:

11. What, if any, barriers exist to applying the information presented at this event? ___________________________________________________________

12. What about the event was most useful to you? ___________________________________________________________

13. How could this event be improved? ___________________________________________________________

Thank you for completing our survey.