Afterschool Center Coaching Log

Appendix C:
Afterschool Center Coaching Log

OMB No.: xxxx-xxxx Expiration Date: xx/xx/xxxx

U.S. DEPARTMENT OF EDUCATION

National Study of Continuous Quality Improvement to Inform the 21st Century Community Learning Centers Program

Afterschool Center Coaching Log

This afterschool center coaching log is part of the National Study of Continuous Quality Improvement to Inform the 21st Century Community Learning Centers Program, a national evaluation being conducted for the U.S. Department of Education by Mathematica. This afterschool center coaching log collects information each time you coach a center staff member from November 2021 through June 2023. In this log, you will record how long you spent coaching a specific center staff member and the focus of the coaching activities. If you have any questions about the study or your center’s participation, email us at [STUDY EMAIL]@mathematica-mpr.com.

We would like you to know the following:

• The log takes about 5 minutes to complete.

• Your answers will be very valuable for the study to understand the coaching that afterschool center leaders and staff carry out to support their colleagues.

• Your answers will be completely confidential; no information that identifies you, your staff, your center, or your regional or district afterschool program will be reported. Your responses are protected from disclosure per the policies and procedures required by the Education Sciences Reform Act of 2002, Title I, Part E, Section 183. The study team will present the information collected as part of this study in an aggregate form and will not associate responses to any of the people who participate. We will not provide information that identifies you, your staff, your center, or your program to anyone outside the study team except if required by law. Your responses will be used only for statistical purposes. The reports prepared for this study will summarize findings across the sample and will not associate responses with a specific district, program, afterschool center, or person. Any willful disclosure of such information for nonstatistical purposes, without the informed consent of the respondent, is a class E felony.

• Completing this log does not pose any special risks to you as a respondent. The study has safeguards in place to ensure respondents’ confidentiality, including restricted access to log data and separating identifying information such as staff and center names from survey responses. All members of the study team sign a confidentiality pledge, and all staff with access to identifiable study data have received clearance from the U.S. Department of Education and are subject to severe legal consequences for any breach of confidentiality. Any data that identifies you will be destroyed at the end of the study. If you have any questions about your rights as a study participant, contact HML IRB toll free at 1-202-753-5040 and reference IRB number 844MATH21.

I have read and I understand the above statements and agree to participate in this log.

If you would like a copy of this disclosure statement, please contact Kristina Rall at

KRall@mathematica-mpr.com or (202) 264-3468.

Paperwork Reduction Act Statement - This information collection meets the requirements of 44 U.S.C. § 3507, as amended by section 2 of the PPaperwork Reduction Act of 1995. You do not need to answer these questions unless we display a valid Office of Management and Budget control number. The OMB control number for this information collection is XXXX-0XXX, expiring xx-xxx-20xx. We estimate that it will take about 5 minutes to read the instructions, gather the facts, and answer the questions. If you have any comments concerning the accuracy of the time estimate or suggestions for improving this form, please write to U.S. Department of Education, Washington, DC 20202. If you have comments or concerns regarding the content or the status of your individual submission of this form, write directly to U.S. Department of Education, Institute of Education Sciences, 550 12th Street, SW, Washington, DC 20202. Send only comments relating to our time estimate to this address, not the completed form.

Afterschool Center Coaching Log

Welcome back, [Coach name auto-populated]! Please complete this log after each reflection conversation you have with a staff member at your center. A reflection conversation is a conversation in which you provide feedback to a staff member or help the staff member reflect on his or her practices. Please complete this log for both reflection conversations that are scheduled in advance and those that are not.

A1. Please select the name of the center staff member with whom you conducted this reflection conversation. If the staff member’s name does not appear below, please select “Other staff member” and enter the staff member’s first and last name.

Select one only

 [Staff name auto-populated #1] 1

 [Staff name auto-populated #2] 2

 [Staff name auto-populated #3] 3

 [Staff name auto-populated #4] 4

 [Staff name auto-populated #5] 5

 [Staff name auto-populated #6] 6

 Other staff member (Please specify) 7

First Name

Last Name

A2. Please indicate the position that best describes [Staff name auto-populated]’s role at the center.

Select one only

 Center director 1

 Co-lead 2

 Other paid staff member 3

 Volunteer 4

A3. Please indicate the grade levels of the students with whom [Staff name auto-populated] regularly interacts at the center.

Select all that apply

 Kindergarten 1

 1 2

 2 3

 3 4

 4 5

 5 6

 6 7

 7 8

 8 9

 9 10

 10 11

 11 12

 12 13

These next questions ask about the reflection conversation you conducted with [Staff name auto- populated].

A4. Please enter the date of the reflection conversation you conducted with [Staff name auto- populated].

MM DD YYYY

A5. Was the reflection conversation with [Staff name auto-populated] on [Date auto-populated from A4] scheduled in advance?

 Yes 1

 No 0

A6. How long was the reflection conversation with [Staff name auto-populated] on [Date auto- populated from A4]?

Select one only

 1-15 minutes 1

 16-30 minutes 2

 31-45 minutes 3

 46-60 minutes 4

 More than 1 hour 5

A7. Which of the following practices was the primary focus of this reflection conversation for [Staff name auto-populated]?

Select all that apply from the following topics that most closely describe the primary focus of this reflection conversation. A topic was the primary focus of the reflection conversation if a substantial portion of the reflection conversation focused on the topic.

The topics listed below are practices measured by the Program Quality Assessment. If the reflection conversation focused on a topic that is not in this list, please specify the topic(s) in the spaces provided below.

Select all that apply

 Providing a safe and welcoming environment 1

 Helping students be aware of and constructively handle their emotions 2

 Scaffolding students' learning 3

 Fostering students’ growth mindset (the belief that they can improve their skills and that their success depends on their effort) 4

 Providing students with opportunities to collaborate and work cooperatively with other students 5

 Providing students with opportunities to grow in responsibility and leadership 6

 Supporting students in practicing empathy 7

 Providing students with opportunities to make choices based on their interests 8

 Providing students with opportunities to plan, set goals, and solve problems 9

 Planning, presenting, and pacing activities effectively 10

 Supporting students’ active engagement in activities 11

 Providing students with opportunities to develop a sense of belonging 12

 Providing students with opportunities to reflect 13

 Other practice (please specify) 14

Specify

 Other practice (please specify) 15

Specify

 Other practice (please specify) 16

Specify

A8. What plan(s) for next steps resulted from the reflection conversation with [Staff name auto-populated]?

Select all that apply

 I scheduled an observation with the staff member 1

 I scheduled a reflection conversation with the staff member 2

 I scheduled a time to model a specific practice for the staff member 3

 I plan to organize an additional training session for staff 4

 I plan to request additional support from the Weikart Center 5

 I plan to identify or search for additional resources to share 6

 The staff member agreed to implement a specific strategy 7

 The staff member agreed to review training materials again 8

 The staff member agreed to view an online training from the Weikart

Center 9

 Other plan for a next step (please specify) 99

Specify

 None 0

These next questions ask about any observation you conducted for [Staff name auto-populated] to inform this reflection conversation.

A9. Did you conduct an observation of [Staff name auto-populated]’s interactions with students to inform this reflection conversation?

 Yes 1

 No 0 Go to END

A10. Please enter the date on which you observed [Staff name auto-populated] to inform this reflection conversation.

MM DD YYYY

A11. How much time did you spend observing [Staff name auto-populated] on [Date auto- populated from A10]?

Select one only

 1-15 minutes 1

 16-30 minutes 2

 31-45 minutes 3

 46-60 minutes 4

 More than 1 hour 5

END. Thank you for completing this coaching log.