OMB Control No: 0970-0356
Expiration Date: 0 2/29/2024
Facilitator Follow-up Survey
DRAFT
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 twaits@mathematica-mpr.com.. |
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 twaits@mathematica-mpr.com 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.
Thinking about class sessions where you teach youth, please respond to the following statements:
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Strongly disagree |
Disagree |
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Agree |
Strongly agree |
a. I feel comfortable using co-regulation strategies in class. |
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b. Using co-regulation strategies improves my teaching. |
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c. Using co-regulation strategies makes my job easier. |
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d. Using co-regulation strategies makes my teaching more complicated. |
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e. Using co-regulation strategies creates more work for me. |
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f. I feel like I have the support I need to use co-regulation strategies in class. |
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g. I believe using co-regulation strategies increases youth’s engagement with the content. |
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The following statements describe beliefs people have about self-regulation. Please mark your level of agreement with the following statements.
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Strongly agree |
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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.
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About half of the time |
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Almost always |
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Adapted from Difficulties in Emotional Regulation Scale; Gratz and Roemer 2004
Please think about what you typically do when teaching youth and indicate your level of agreement with each of the statements below.
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Strongly disagree |
Disagree |
Neither disagree nor agree |
Agree |
Strongly agree |
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Adapted from Socio-Emotional Guidance Questionnaire; Jacobs et al. 2013
Thank you for sharing your experiences with us today.
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