Form 1 Healthy Native Babies Project Train-the-Trainer Follow-U

OMB Number: 0925-0701

Expiration Date: 07/31/2017

Healthy Native Babies Project Train-the-Trainer Follow-Up Assessment

Thank you for participating in this follow up assessment. It should take no longer than 15 minutes to complete. The questions are about your activities since attending the Healthy Native Babies Project Train-the Trainer session in [fill in training location for each IHS Area cohort]. This assessment will refer to the Healthy Native Babies Project Train-the Trainer session as ‘the Training’. You may want to refer to your calendar to answer questions about activities conducted since attending the Training.

First, the following are general questions about your work.

1. Since attending the Training, has your job changed? That is, do you work for a different agency or organization, have you changed positions within the same agency, or have your responsibilities changed substantially?

____Yes

____No  SKIP TO QUESTION 3

2. What type of work are you currently employed in? CHECK ALL THAT APPLY.

____Public Health Nursing

____Community Health Representative

____WIC

____Other Home Visiting (Healthy Start)

____OBGYN or Labor and Delivery

____Pediatrics

____Health Education and Promotion

____Behavioral Health

____Injury Prevention

____Child Care or Early Childhood Education

____Child Welfare, Protective Services, or Social Services

____Other Law Enforcement

____Other (Please tell us: _______________)

Please answer the rest of the questions on this page about your current position.

3. On average, in a year, how many of your clients or patients are parents or caregivers of American Indian/Alaska Native infants?

____All

____Most

____About half

____A few

____None

____I do not provide direct service to patients or clients

4. On average, in a year, how many trainings for service providers do you conduct in your regular work? (If you do not conduct training for service providers, please put a ‘0’ in the space below.)

_____ Trainings

Dissemination of Health Education Materials about SIDS and Other Sleep-Related Causes of Infant Death

Please answer the questions on this page about the entire period since you attended the training, even if your job has changed.

5. Since attending the Training, which health education print materials, if any, have you created using the Healthy Native Babies Project Toolkit Disk? CHECK ALL THAT APPLY.

____Brochures

____Flyers (8 ½ x 11 with white background)

____Posters (11 x 17 full color)

____Postcards

____Other materials (Please tell us: ____________________)

____None

6. Did you have any problems using the Healthy Native Babies Project Toolkit Disk?

____Yes (Please tell us what problems you had: ______________________________)

____No

7. Since attending the Training, have you ordered any of the following Healthy Native Babies Project materials from the NICHD Information Resource Center? CHECK ALL THAT APPLY.

____ Safe Sleep for Your Baby Brochure

____Honor the Past, Learn for the Future Flyer

____Healthy Native Babies Project Workbook Packet

____Healthy Native Babies Project Facilitator’s Packet

8. Since attending the Training, which Healthy Native Babies Project print materials (customized materials or those ordered from the NICHD Information Resource Center), if any, have you distributed in the communities where you work? CHECK ALL THAT APPLY.

____Brochures

____Flyers (8 ½ x 11 with white background)

____Posters (11 x 17 full color)

____Postcards

____Other materials (Please tell us: ___________________)

____None

9. Since attending the Training, from what other source(s), if any, have you ordered or received health education print materials about SIDS or other sleep-related causes of infant death risk-reduction?

10. Since attending the Training, have you distributed print materials on SIDS or other sleep-related causes of infant death that you received from other sources in the communities where you work?

____Yes

____No

Risk-Reduction Education, Trainings, and Presentations on SIDS and Other Sleep-related Causes of Infant Death

11. Since attending the Training, which of the following activities addressing SIDS or other sleep-related causes of infant death have you conducted? CHECK ALL THAT APPLY.

____Delivered risk-reduction education to parents or caregivers in a clinic, office, or other service delivery site

____Delivered risk-reduction education to parents or caregivers in their home

____Delivered risk-reduction education to a community group

____Conducted training for service providers on delivering risk-reduction education

____Conducted training for parents, caregivers, or community members on delivering risk-reduction education

to their peers

____Presented information to service providers

____Presented information to tribal leadership or other policy makers

____None

____Other activity. Please tell us: __________________________________

12. Since attending the Training, to how many of your patients or clients have you delivered risk-reduction education about SIDS or other sleep-related causes of infant death?

___All patients/clients

___Most patients/clients

___About half of your patients/clients

___Few patients/clients

___None of your patients/clients

___I do not provide direct service to patients or clients

13. Since attending the Training, how many trainings have you conducted for service providers on delivering risk-reduction education about SIDS and other sleep-related causes of infant death? (If you have not conducted any training, please put a ‘0’ in the space below.)

___ Trainings

14. Since attending the Training, how many trainings have you conducted for parents, caregivers, or community members on delivering risk-reduction education about SIDS and other sleep-related causes of infant death to their peers? (If you have not conducted any training, please put a ‘0’ in the space below.)

___Trainings

Healthy Native Babies Project Support Materials and Follow up Activities

15. Since attending the Training, which files from the Resource Disk have you used? CHECK ALL THAT APPLY.

­­­­___PowerPoint Presentations

___Health Education Activities

___None

16. Since attending the Training, have you used the Healthy Native Babies Project Workbook?

____Yes

____No

Feedback on the Training

17. Please think back to the Training that you attended. What parts, if any, have been the most useful in preparing you to conduct risk-reduction training for service providers on SIDS and other sleep-related causes of infant death? CHECK ALL THAT APPLY.

_____Healthy Native Babies Project and SIDS risk-reduction overview

_____Overview of key messages for Healthy Native Babies Project activity workstations

_____Teach back demonstrations to my peers

_____Community outreach overview

_____Local training work plan development

_____Healthy Native Babies Project Workbook, Resource Disk, and Toolkit Disk

_____Networking with participants

_____None

18. What parts of the Training, if any, could be improved to better prepare you to conduct risk-reduction training for service providers on SIDS and other sleep-related causes of infant death? CHECK ALL THAT APPLY.

_____Healthy Native Babies Project and SIDS risk-reduction overview

_____Overview of key messages for Healthy Native Babies Project activity workstations

_____Teach back demonstrations to my peers

_____Community outreach overview

_____Local training work plan development

_____Healthy Native Babies Project Workbook, Resource Disk, and Toolkit Disk

_____Networking with participants

_____None

19. Please tell us how we can improve the Training.

20. What challenges have you experienced in conducting health education or training on SIDS and other sleep-related causes of infant death?

21. What successes have you achieved in conducting health education or training on SIDS and other sleep-related causes of infant death?

Please select the option that best describes how much you agree or disagree with the statements below.
22.	I am confident in my overall knowledge of SIDS and other sleep-related causes of infant death.	Strongly Agree	Agree	Disagree	Strongly Disagree
23.	I can educate parents and caregivers about SIDS and other sleep-related causes of infant death.	Strongly Agree	Agree	Disagree	Strongly Disagree
24.	I can help parents and caregivers reduce the risk of SIDS and other sleep-related causes of infant death.	Strongly Agree	Agree	Disagree	Strongly Disagree
25.	I can demonstrate how to make a baby’s sleep environment safer.	Strongly Agree	Agree	Disagree	Strongly Disagree
26.	I can train service providers to deliver risk-reduction education about SIDS and other sleep-related causes of infant death.	Strongly Agree	Agree	Disagree	Strongly Disagree
27.	I can teach service providers to talk with mothers about how smoking or second-hand smoke exposure can increase the risk of SIDS.	Strongly Agree	Agree	Disagree	Strongly Disagree
28.	I can teach elders who smoke not to smoke inside a house or vehicle when an infant is inside.	Strongly Agree	Agree	Disagree	Strongly Disagree
29.	I will conduct training for service providers on SIDS and other sleep-related causes of infant death within the next three months.	Strongly Agree	Agree	Disagree	Strongly Disagree
30.	I will deliver risk-reduction education to parents or caregivers about SIDS and other sleep-related causes of infant death within the next three months.	Strongly Agree	Agree	Disagree	Strongly Disagree
31.	I will give out Healthy Native Babies Project health education print materials in the communities where I work within the next three months.	Strongly Agree	Agree	Disagree	Strongly Disagree

Thank you for completing this follow-up assessment. Your feedback will help us to improve the Healthy Native Babies Project.

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