CMHIS Eval Survey: Implementation Support - Basic TA - Center for Mental Health Implementation Support (CMHIS)

CMHIS Basic TA Participant Survey

Post-event survey

TTA GPRA Post-Event Form (GPRA-PEF)

Form Approved
OMB NO. 0930-0389

Public reporting burden for this collection of information is estimated to average 10 minutes to complete this questionnaire. Send comments regarding this burden estimate or any other aspect of this collection of information to the Substance Abuse and Mental Health Services Administration (SAMHSA) Reports Clearance Officer, Room 15E57A, 5600 Fishers Lane, Rockville, MD 20857. 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 Office of Management and Budget (OMB) control number. The control number for this project is 0930-0389.

This questionnaire aims to gather your feedback regarding the quality and usefulness of this event. The information you provide will be used to enhance and improve future training events. Your answers will not be released to anyone and will remain anonymous. Your name will not be written on the questionnaire or be kept in any other records. All responses you provide for this study will remain confidential.

When the results of the questionnaire are reported, you will not be identified by name or any other information that could be used to infer your identity. Only SAMHSA and its grantee will have access to view any data collected. Your participation is voluntary, and you may withdraw from completing this questionnaire at any time you wish or skip any question you don’t feel like answering.

Your refusal to participate will not result in any penalty or loss of benefits to which you are otherwise entitled.

The following questions are designed to assess the quality of today’s event.

How satisfied were you with the overall quality of this event?

I expect this event to benefit me and/or my community.

I expect this event will improve my ability to work effectively.

I would recommend this event to a friend/colleague.

Yes

No

What about the event was most useful to you?

How could this event be improved?

In order for SAMHSA to continuously improve its training programs, it is important that we know a bit about those we are currently serving. Your reply to these demographic questions will help SAMHSA to improve its technical assistance programs. Please note that your responses will be reported in aggregate.

Are you Hispanic, Latino/a, or Spanish origin?

Yes

No

Prefer not to answer

[IF YES] What ethnic group do you consider yourself? You may indicate more than one.

What is your race? You may indicate more than one.

Please select the best category that describes your community (Select one or more):

Metropolitan or Suburban Community (communities located in a city or town)

Tribal Community (any American Indian or Alaska Native tribe, band, nation, pueblo, village, or community)

Rural or Frontier Community (sparsely populated areas that are geographically isolated from population centers and services, usually has few homes or other buildings, and not very many people)

Unknown

Other (Specify)Other (Specify)

What is the highest degree you have received? (Select one):

Less than 12th Grade

12th Grade/High School Diploma/Equivalent

Vocational/Technical (Voc/Tech) Diploma

Some College or University

Bachelor’s Degree (For example: BA, BS)

Graduate Work/Graduate Degree

Prefer not to answer

Other (Specify)Other (Specify)

What is your primary occupation/profession? (Select one):

If you are a Student, what is your primary field of study? (If Not a Student SKIP this question)

Which of the following best describes your principal employment setting? (Select one):

What is the ZIP Code of your principal employment setting or school (if you are a student)?

What is your sex? [OPTIONAL]

Male

Female

(END GPRA PORTION OF SURVEY)

CMHIS Post-event Survey for Basic TA

Thank you for participating in this implementation support event. We value your input on this event. Please complete the additional questions below.

Please use the following scale to describe your CONFIDENCE in your abilities BEFORE and AFTER the implementation support event:

BEFORE the event

AFTER the event

Please rate your level of agreement with each of the following statements about the skills and strategies you learned in this implementation support event.

What are two ways you could use what you learned from this implementation support event in your work?

What else would you like to learn about the topics covered in this implementation support event?

Indicate the primary location of your organization. Select one.

What is the approximate size of your organization?

1-20 employees

21-60 employees

61-100 employees

>100 employees

Does your organization receive funding from SAMHSA?

Yes

No

Unsure

Please use the space below to share anything else about your experience with this implementation support event that you would like us to know.

CMHIS Eval Survey: Implementation Support – Basic TA

CMHIS Basic TA Participant Survey

Post-event survey

(END GPRA PORTION OF SURVEY)

CMHIS Post-event Survey for Basic TA

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