Sexual Risk Avoidance Education National Evaluation: Formative Evaluation for the Program Components Impact Study

OMB Control No: 0970-0356

Expiration Date: 0 2/29/2024

Facilitator Follow-up Survey

DRAFT

August 2022

THE PAPERWORK REDUCTION ACT OF 1995

This collection of information is voluntary and will be used to provide the Administration for Children and Families with information to help refine and guide program development in the area of adolescent pregnancy prevention. Public reporting burden for the collection of information is estimated to average 5 minutes per response, including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing 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. The OMB number and expiration date for this collection are OMB #: 0970-0356, Exp: 02/29/2024. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to Tiffany Waits at [email protected]..

Thank you in advance for taking this survey! This study is sponsored by the Administration for Children and Families (ACF) within the U.S. Department of Health and Human Services and is being conducted by Mathematica. The purpose of this short survey is to learn about your experience using co-regulation strategies when teaching the Love Notes curriculum. The information you provide will help ACF learn about your experiences using co-regulation strategies after receiving training.

Your participation in this survey is voluntary. There are no risks or benefits associated with completing the survey, which should take about 5 minutes. We will not collect any personal information (for example, your name, email, or phone number) as part of the survey. Your answers will remain private, except as required by law, and no staff at your organization will see your individual responses. We hope you answer all survey questions, but you may skip any question you do not want to answer.

If you have any questions or comments about this information collection, contact Tiffany Waits, the survey director, at [email protected] or (202) 264-3498. If you have any questions or concerns about your rights as a study participant, please contact the Health Media Lab Institutional Review Board at (202) 246-8504.

If you agree to participate in this survey, click NEXT to begin.

1. Thinking about class sessions where you teach youth, please respond to the following statements:

   	Strongly disagree	Disagree	Neither disagree nor agree	Agree	Strongly agree
   a. I feel comfortable using co-regulation strategies in class.	1 m	2 m	3 m	4 m	5 m
   b. Using co-regulation strategies improves my teaching.	1 m	2 m	3 m	4 m	5 m
   c. Using co-regulation strategies makes my job easier.	1 m	2 m	3 m	4 m	5 m
   d. Using co-regulation strategies makes my teaching more complicated.	1 m	2 m	3 m	4 m	5 m
   e. Using co-regulation strategies creates more work for me.	1 m	2 m	3 m	4 m	5 m
   f. I feel like I have the support I need to use co-regulation strategies in class.	1 m	2 m	3 m	4 m	5 m
   g. I believe using co-regulation strategies increases youth’s engagement with the content.	1 m	2 m	3 m	4 m	5 m

2. The following statements describe beliefs people have about self-regulation. Please mark your level of agreement with the following statements.

	Strongly disagree	Disagree	Neither disagree nor agree	Agree	Strongly agree
Self-regulation is something people are born with and is impossible to change later in life.	1 m	2 m	3 m	4 m	5 m
Self-regulation is linked with positive outcomes in several different areas of life, including education, employment, and health.	1 m	2 m	3 m	4 m	5 m
Self-regulation includes being able to see things from other points of view.	1 m	2 m	3 m	4 m	5 m
Brain development during adolescence and young adulthood makes it an important time for supporting self-regulation skill development.	1 m	2 m	3 m	4 m	5 m
After youth start high school, there is very little parents and other adults can do to help them develop self-regulation skills.	1 m	2 m	3 m	4 m	5 m
Teachers and mentors don’t spend enough time with youth to have an impact on their self-regulation skill development.	1 m	2 m	3 m	4 m	5 m
When people have an opportunity to practice how they will behave in a situation ahead of time, it is more likely they will behave that way when the time comes.	1 m	2 m	3 m	4 m	5 m
Brain development is complete by adolescence (around 14 years old).	1 m	2 m	3 m	4 m	5 m
Poverty and stress can negatively affect youth’s development of self-regulation skills.	1 m	2 m	3 m	4 m	5 m
Friends do not have much impact on the self-regulation skill development of their peers.	1 m	2 m	3 m	4 m	5 m
Adolescents are old enough to take responsibility for achieving their goals on their own.	1 m	2 m	3 m	4 m	5 m

3. Think about your own self-regulation skills and. indicate how often the following statements apply to you. All of your responses will remain private. No one from your organization will see your responses to questions in this survey.

	Almost never	Sometimes	About half of the time	Most of the time	Almost always
When I’m stressed, I have difficulty getting work done.	1 m	2 m	3 m	4 m	5 m
When I’m stressed, I have difficulty thinking about anything else.	1 m	2 m	3 m	4 m	5 m
When I’m stressed, I can still get work done.	1 m	2 m	3 m	4 m	5 m
When I’m stressed, I have difficulty concentrating.	1 m	2 m	3 m	4 m	5 m
When I’m stressed, I believe that I will remain that way for a long time	1 m	2 m	3 m	4 m	5 m
I experience my emotions as overwhelming and out of control	1 m	2 m	3 m	4 m	5 m
When I’m upset, I feel like I can remain in control of my behaviors.	1 m	2 m	3 m	4 m	5 m
When I’m upset, I know that I can find a way to eventually feel better.	1 m	2 m	3 m	4 m	5 m
When I’m upset, I start to feel very bad about myself.	1 m	2 m	3 m	4 m	5 m
When I’m upset, I believe wallowing in it is all I can do.	1 m	2 m	3 m	4 m	5 m
When I’m upset, my emotions feel overwhelming.	1 m	2 m	3 m	4 m	5 m

Adapted from Difficulties in Emotional Regulation Scale; Gratz and Roemer 2004

4. Please think about what you typically do when teaching youth and indicate your level of agreement with each of the statements below.

	Strongly disagree	Disagree	Neither disagree nor agree	Agree	Strongly agree
Working on improving youths’ self-regulation diverts attention from important class content.	1 m	2 m	3 m	4 m	5 m
The best support for self-regulation is provided by a specialized team of external care providers (for example, school counselors, mental health care providers).	1 m	2 m	3 m	4 m	5 m
I cannot respond to all youth in my classroom who need help with self-regulation skills.	1 m	2 m	3 m	4 m	5 m
In my classroom, youth must primarily be allowed to be themselves and discover themselves.	1 m	2 m	3 m	4 m	5 m
My main task in this program is to assist youth on their road to adulthood.	1 m	2 m	3 m	4 m	5 m
I regularly assess the emotional, cognitive, and behavioral self-regulation development of youth in the program.	1 m	2 m	3 m	4 m	5 m
I talk to youth about their self-regulation development.	1 m	2 m	3 m	4 m	5 m
I try to help youth find solutions for their self-regulation issues.	1 m	2 m	3 m	4 m	5 m
In my lessons, I try to explicitly foster the self-regulation development of youth.	1 m	2 m	3 m	4 m	5 m

Adapted from Socio-Emotional Guidance Questionnaire; Jacobs et al. 2013

Thank you for sharing your experiences with us today.