TTA Follow up Form TTA Follow up Form

Training and Technical Assistance (TTA) Program Monitoring

Attachment 3_TTA Follow Up Form_1-28-2022

OMB: 0930-0389

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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.

Shape1 Strongly Agree

Shape2 Agree

Shape3 Neutral

Shape4 Disagree

Shape5 Strongly Disagree


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

Shape6 Strongly Agree

Shape7 Agree

Shape8 Neutral

Shape9 Disagree

Shape10 Strongly Disagree


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

Shape11 Strongly Agree

Shape12 Agree

Shape13 Neutral

Shape14 Disagree

Shape15 Strongly Disagree



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

Shape16 Strongly Agree

Shape17 Agree

Shape18 Neutral

Shape19 Disagree

Shape20 Strongly Disagree

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

Shape21 Strongly Agree

Shape22 Agree

Shape23 Neutral

Shape24 Disagree

Shape25 Strongly Disagree



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

Shape26 Yes

Shape27 No



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

Shape28 Handouts and resources

Shape29 Online resources

Shape30 General information acquired

Shape31 New ideas to help my community

Shape32 New ideas to help my practice/patients/consumers

Shape33 Networking/interaction with trainers/leaders and participants

Shape34 Learning new modalities/interventions to improve life in my community

Shape35 Learning new modalities/interventions to improve my practice

Shape36 Learning how to be more empathic with community members or patients/consumers

Shape37 Better understanding of the content of the event

Shape38 Better understanding of patients/consumers’ needs

Shape39 Learning the importance of making ongoing improvements to my practice

Shape40 Other: ________________________________________



  1. 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)

Shape41 Improved communication/interaction with patients/consumers/participants/key stakeholders

Shape42 Improved communication with staff

Shape43 Improved leadership/management style

Shape44 Increased awareness of patients/consumers/participants/key stakeholders’ needs

Shape45 Better application of culturally responsive practices

Shape46 Adopted new practices/interventions

Shape47 Improved implementation of existing practices/interventions

Shape48 Implemented telehealth

Shape49 Expanded access to underserved populations

Shape50 Improved collection and/or use of assessment and/or evaluation data

Shape51 Adapted programs, policies, practices, or other interventions to meet local culture

Shape52 Improved community readiness and/or increased community mobilization

Shape53 No change

Shape54 Another _____________________________________________



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

Shape55 Improved my understanding of the subject

Shape56 Inspired me to learn more about the subject

Shape57 Prepared me to better serve patients/consumers/participants/key stakeholders

Shape58 Helped me to choose a specialty area

Shape59 It did not

Shape60 Other ________________________________________________



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

Shape61 Better understanding of substance use disorders and/or mental illness

Shape62 Better understanding of effective behavioral health interventions

Shape63 Increased implementation of prevention programs

Shape64 Better communication with family or community members

Shape65 Increased awareness of community members’ needs

Shape66 Increased community action/group action/collective advocacy

Shape67 Enhanced community dialogue or increased accessibility to support groups

Shape68 Decreased stigma toward people with substance use disorders or mental illness

Shape69 Collective sense of wellbeing

Shape70 No change

Shape71 Other ______________________________________



Open-ended questions:



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

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

  3. How could this event be improved? ___________________________________________________________



Thank you for completing our survey.

File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
File TitleTechnology Transfer Center (TTC) GPRA Follow-up Form
SubjectFollow-up form for the Technology Transfer Center (TTC) network
AuthorSubstance Abuse and Mental Health Services Administration (SAMHS
File Modified0000-00-00
File Created2022-09-12

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