RISE Posttest
Date: / /
Included in this packet are your survey, the consent information sheets, and a security envelope.
Please read the enclosed consent information sheet carefully and thoroughly prior to beginning your survey. Then, decide whether you would like to complete this survey. If you choose to complete the survey, please answer the questions about your views and experiences with lesbian, gay, bisexual, transgender, and questioning (LGBTQ) clients and the availability of agency resources to facilitate work with this population. The survey contains 15 questions that begin on the next page. Turn the page to landscape view to answer the questions. When you are done, please mail a copy of the consent information sheet and the survey in the provided envelope.
Thank you for considering participation in this important study.
Instructions for marking a response:
Please use a blue or black pen to complete this form.
M
X
Option 1 Option 2 Option 3
PLEASE USE blue or black ink. PLACE AN “X” IN THE BOX THAT INDICATES HOW STRONGLY YOU AGREE OR DISAGREE WITH EACH STATEMENT. |
|||||
It’s important for me to: |
Strongly agree |
Agree |
Neither agree nor disagree |
Disagree |
Strongly disagree |
|
☐ |
☐ |
☐ |
☐ |
☐ |
|
☐ |
☐ |
☐ |
☐ |
☐ |
|
☐ |
☐ |
☐ |
☐ |
☐ |
|
☐ |
☐ |
☐ |
☐ |
☐ |
|
☐ |
☐ |
☐ |
☐ |
☐ |
|
☐ |
☐ |
☐ |
☐ |
☐ |
The office or agency where I work provides: |
|
|
|
|
|
|
☐ |
☐ |
☐ |
☐ |
☐ |
|
☐ |
☐ |
☐ |
☐ |
☐ |
|
☐ |
☐ |
☐ |
☐ |
☐ |
PLACE AN “X” IN THE BOX THAT INDICATES HOW FREQUENTLY YOU DO EACH OF THE BEHAVIORS. |
|||||
In my work with all children and youth, I: |
Always |
Usually |
Sometimes |
Rarely |
Never |
|
☐ |
☐ |
☐ |
☐ |
☐ |
|
☐ |
☐ |
☐ |
☐ |
☐ |
|
☐ |
☐ |
☐ |
☐ |
☐ |
|
☐ |
☐ |
☐ |
☐ |
☐ |
|
☐ |
☐ |
☐ |
☐ |
☐ |
|
☐ |
☐ |
☐ |
☐ |
☐ |
Items 1-6 and 10-15 on the LGBTQ Competence Scale are based on the Gay Affirmative Practice (GAP) scale developed by Dr. Catherine Crisp. Retrieved from: https://sites.google.com/site/ccrisp002/gayaffirmativepracticescale. Items 7-9 on the LGBTQ Competence Scale were developed for RISE.
Date of IRB approval of this consent: 11/30/12
Expiration date of IRB approval of this consent: 10/1/13
OMB
NO: xxxx-xxxx
EXPIRATION DATE: xx/xx/xxxx
Burden
Statement: This
collection of information is voluntary and will be used to evaluate
the Permanency Innovations Initiative. Public reporting burden of
this collection of information is estimated to average 15 minutes
per response, including the time for reviewing instructions,
searching existing data sources, gathering and maintaining the data
needed, and completing 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. Send comments regarding this
burden estimate or any other aspect of this collection of
information, including suggestions for reducing this burden, to
Reports Clearance Officer (Attn: OMB/PRA 0970-0355), Office of
Planning, Research and Evaluation, Administration for Children and
Families, Department of Health and Human Services, 370 L’Enfant
Promenade S.W., Washington DC 20447.
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
Author | Liz Quinn |
File Modified | 0000-00-00 |
File Created | 2021-01-26 |