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CMHIS Evaluation Survey: Consultation – Targeted & Intensive Post-event

FINAL: CMHIS Post Eval Survey: Consultation - Targeted & Intensive

CMHIS Evaluation Survey: Consultation - Targeted & Intensive
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.

Event Name:

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.

1. How satisfied were you with the overall quality of this event?
2. I expect this event to benefit me and/or my community.
3. I expect this event will improve my ability to work effectively.
4. I would recommend this event to a friend/colleague.

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?
[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):
What is the highest degree you have received? (Select one):
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 your sex? [OPTIONAL]

(END GPRA PORTION OF SURVEY)

CMHIS Post-event Survey for Consultation

Thank you for participating in the consultation process with CMHIS. We value your input on the support you received. Please complete the additional questions below.

Please rate your level of agreement with each of the following statements about the skills and strategies you learned in the consultation process.
Completely disagree
Disagree
Neither agree nor disagree
Agree
Completely Agree
The consultation enhanced my knowledge in the topic(s) we discussed.
The consultation enhanced my skills in the topic(s) we discussed.
I am confident in my ability to apply the knowledge and skills that I learned in the consultation in my work.
I welcome the use of the strategies I learned in my organization.
The strategies I learned seem applicable to my work.
The strategies I learned seem applicable to my organization.
The strategies I learned seem like a good match for my work.
The strategies I learned seem like a good match for my organization.
The strategies I learned seem implementable in my organization.
I have the necessary support to implement the strategies I learned.
I plan to use the strategies I learned in my work.
I have used the strategies I learned in my work.
I am implementing the strategies as described in the implementation support.
I adapted the strategies to fit my work and/or organization.
I would attend a CMHIS event to learn more about the topic(s) we discussed.
NOTE: Your email address will only be used to communicate about our follow-up evaluation and will not be tied to your responses.