TISS Training Pre- TISS Training Pre-Post Survey

OMB Number:

Expiration Date:

Public Burden Statement: 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 control number for this project is 0930-XXXX. Public reporting burden for this collection of information is estimated to average 0.25 hours per respondent, per year, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to SAMHSA Reports Clearance Officer, 1 Choke Cherry Road, Room 2-1057, Rockville, Maryland, 20857.

TISS Training Pre-Post Survey

Consent to Participate

The U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) is sponsoring a multi-site evaluation of the Advancing Wellness and Resilience in Education (AWARE) and Trauma-Informed Services in Schools (TISS) programs. AWARE provides funding to strengthen school-based mental health programs and build partnerships to ensure that students have access and are connected to appropriate and effective behavioral health services. The purpose of the TISS program is to increase student access to trauma support services and mental healthcare by developing innovative activities to link local school systems with local support and mental health systems, including those under the Indian Health Service.

We are inviting you to participate in two surveys. The first survey asks questions about your knowledge, attitudes, and beliefs before the training in which you are about to participate. The second survey asks the same questions after completing the training. Each survey will take approximately 15 minutes to complete. Your participation in this survey is completely voluntary, and you can choose not to participate. 

Your survey responses will remain confidential throughout the project and will only be shared in aggregate form without ever attributing specific responses to any individual respondent. Taking part in this survey will cause minimal risk. There are no direct benefits for you as a participant. However, it is hoped that through your participation, your community, including schools and community agencies, will be better able to provide mental health services for all students. Lessons learned in your state may also benefit SAMHSA programs in other parts of the country. 

In appreciation of your participation, you will receive a $20 gift card upon completion of both surveys.

If you have questions about this initiative please contact the Project Director, Dr. Colleen Murray, at [email protected]. For questions regarding your rights related to survey participation, you can contact ICF’s Institutional Review Board (IRB) at [email protected].

* Please choose one of the options below and click “next” to confirm:

I have read the above information and I voluntarily agree to participate in this survey.

I have read the above and I DO NOT wish to participate in this survey.

How knowledgeable are you about the following topics? Mark one response.

	Not at all knowledgeable 1	Very little knowledge 2	Some knowledge 3	Knowledgeable 4	Very knowledgeable5
I am knowledgeable about the impact trauma has on a student’s ability to learn.
I am knowledgeable about the impact trauma can have on a student’s social success.
I am knowledgeable about the impact trauma can have on a student’s behavior.
I am knowledgeable about different types of trauma.
I am knowledgeable about the impact of positive and negative emotional states on neurological/brain functioning and learning potential.
I am knowledgeable about the symptoms traumatized students display.
I understand symptoms of trauma may be similar or identical to symptoms of other disability diagnoses.
I am knowledgeable about how my behavior/interaction impacts students who may have experienced trauma.
I am knowledgeable about the steps to take once a student has been identified as experiencing a traumatic event.
I am knowledgeable about the steps to take if I suspect a student is experiencing or has experienced trauma.
I am knowledgeable about community resources available to families of students who may have experienced trauma.

How confident are you in the following areas? Mark one response.

	Not at all confident 1	Slightly confident 2	Somewhat confident 3	Confident 4	Very confident5
I can take steps to support a student who has been identified as experiencing a traumatic event.
I can use strategies with the intent to create a safe environment for students.
I can interact with students who have faced trauma in ways that have positive impacts on their ability to learn.
I can make behavioral observations when interacting with students that will help me identify signs of trauma.
I can use active listening strategies when interacting with students.
I am self-aware and mindful of my interactions with students.
I can de-escalate and manage student behaviors when necessary.
I can be positive with all students.
I can treat students with dignity and respect at all times.
I can provide students opportunities to make choices and decisions that affect them.
I can mediate when students pick on each other.

Are you willing to be contacted again to answer some brief questions about today’s training and follow-up questions about how you’ve used the information and skills you learned in the training? Mark one response. Yes No

[If Yes] Please provide the information below so we can contact you for future surveys.

Full Name:

Work email address:

Personal email address:

Mobile phone number:

NOTE: Text (SMS) messages with survey links will be sent to the mobile phone number if provided.

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