Registrant ID ________
Infant Adoption Awareness Training Program (IAATP)
Trainee Survey
Instrument B: Follow-Up Survey
Dear IAATP Participant:
You attended an Infant Adoption Awareness Training session approximately three months ago, and feedback on the training content was requested at that time. Now that some time has passed, we would again appreciate your feedback on this educational event. We are particularly interested in whether you have been able to apply the knowledge gained from that course to your daily routine practices that involve providing services to women.
Information gathered from this effort will help to improve the quality of the training.
Completion of the form will take approximately 10 minutes and is voluntary. All information gathered from the form is anonymous. No individual responses are reported. Data will be presented only in aggregate form.
You may decline to participate without penalty.
Please provide your feedback by completing the form at the following web site: http://_____________. You may access the site either by pressing ctrl+ enter or by copying the web address and placing it in your browser. If you are unable to complete the survey online, please return a completed copy of this form to James Bell Associates by email, fax, or mail.
Email: iaatp@jbassoc.com
Fax: (703) 243-3017
James Bell Associates
Attn: IAATP
1001 19th Street, North; Suite 1500
Arlington, VA 22209.
Once your completed survey is received, a gift certificate or card in the amount of $10 will be sent to you to thank you for your time.
Thank you in advance for your participation.
What is your primary role at work? (Check one)
Administrator (non-clinical)
Physician Assistant/Nurse Practitioner
Social Worker/Case Manager/Counselor/Therapist
Certified Nurse Midwife/Midwife/Doula
Health Educator/Instructor
Office Manager/Administrative Support
Physician/MD/DO/Psychiatrist
Nurse (RN/PHN/LPN/NA)
Other (specify) ___________________________________
Which best describes the services you normally provide to women with unintended pregnancies? (Mark all that apply)
I give clients brochures, pamphlets or handouts
I discuss community resources with clients
I make referrals to community resources
I provide options counseling
I make assessments of individuals’ needs
I have not provided any of these services
Approximately how many clients with unintended pregnancies have you personally encountered in the last month? __________ clients
On average, how much time do you spend per client providing options information or referral services? (If you do not provide these services, enter “N/A”) __________ minutes
When talking to clients with an unintended pregnancy about their options:
How often do you engage in the following activities?
(If you do not provide options counseling, mark “N/A.” )
i. I use open-ended questions |
Often Sometimes Rarely Never N/A |
ii. I help clients find their own answers |
Often Sometimes Rarely Never N/A |
iii. I try to make the discussion interactive |
Often Sometimes Rarely Never N/A |
iv. I let my values guide the discussion |
Often Sometimes Rarely Never N/A |
How likely are you to talk about adoption as an option with clients who are experiencing an unintended pregnancy?
Very likely
Likely
Somewhat likely
Not likely
Not likely at all
N/A
How often do you engage/involve birth fathers in the discussions?
Often
Sometimes
Rarely
Never
N/A
Do you provide the following types of referrals, if requested? (Mark all that apply)
Prenatal care and delivery
Pregnancy termination
Infant care
Foster care
Adoption
I don’t make referrals
Do you communicate or collaborate with licensed adoption agencies for clients who are interested in adoption?
Yes
No
N/A
On average, how often do you refer interested clients to adoption agencies/resources for additional information?
Never
Once a month or less
Two to three times a month
Once a week
Two to four times a week
Daily
N/A
Have you coached or trained other professionals on presentation of the adoption option?
Yes
No
How often do you engage in the following activities?
a. Discuss the client’s reaction to the pregnancy |
Often Sometimes Rarely Never N/A |
b. Discuss the advantages and disadvantages of the various pregnancy options with clients |
Often Sometimes Rarely Never N/A |
c. Assess the client’s need for other supportive services |
Often Sometimes Rarely Never N/A |
d. Discuss the possibility of including other family members in future discussions |
Often Sometimes Rarely Never N/A |
e. Explain the rights of birth mothers, birth fathers, and families according to applicable federal and state laws |
Often Sometimes Rarely Never N/A |
Mark each item “True” or “False”
|
True False |
|
True False |
|
True False |
|
True False |
|
True False |
|
True False |
|
True False |
|
True False |
|
True False |
|
True False |
|
True False |
|
True False |
|
True False |
|
True False |
|
True False |
|
True False |
|
True False |
|
True False |
|
True False |
|
True False |
|
True False |
|
True False |
|
True False |
|
True False |
|
True False |
|
True False |
How would you describe your overall opinion about adoption?
Very favorable
Somewhat favorable
Neither favorable or unfavorable
Somewhat unfavorable
Very unfavorable
How familiar are you with the adoption process?
Very familiar Somewhat familiar Not at all familiar
Select the response that best reflects your opinion.
I believe that adoption: |
Strongly Agree |
Agree |
Neither agree or disagree |
Disagree |
Strongly Disagree |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Do you agree or disagree with the following statements?
|
Strongly Agree |
Agree |
Neither agree or disagree |
Disagree |
Strongly Disagree |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Do you think children adopted as infants are more likely, equally likely, or less likely than other children to:
|
More likely Equally likely Less likely |
|
More likely Equally likely Less likely |
|
More likely Equally likely Less likely |
|
More likely Equally likely Less likely |
|
More likely Equally likely Less likely |
|
More likely Equally likely Less likely |
|
More likely Equally likely Less likely |
Instruction: Mark “N/A” for any item that is not applicable to the work that you perform.
Which aspects of the Infant Adoption Awareness Training have you found useful in your work with pregnant clients?
|
Topic Covered? |
Very Useful |
Somewhat Useful |
Not Useful |
N/A |
|
Yes No |
|
|
|
|
|
Yes No |
|
|
|
|
|
Yes No |
|
|
|
|
|
Yes No |
|
|
|
|
|
Yes No |
|
|
|
|
|
Yes No |
|
|
|
|
|
Yes No |
|
|
|
|
|
Yes No |
|
|
|
|
How useful have the following resources from the training been in your work with pregnant clients?
|
Received? |
Very Useful |
Somewhat Useful |
Not Useful |
N/A |
|
Yes No |
|
|
|
|
|
Yes No |
|
|
|
|
|
Yes No |
|
|
|
|
|
Yes No |
|
|
|
|
|
Yes No |
|
|
|
|
|
Yes No |
|
|
|
|
Describe what you have experienced when you use the training in your work?
When I follow the guidelines presented in the Infant Adoption Awareness training program with pregnant clients, I find that…
|
Strongly Disagree
|
Disagree
|
Neither Agree nor Disagree |
Agree |
Strongly Agree |
N/A
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
What, if any, barriers have you encountered to using the Infant Adoption Awareness training in your work? (Mark all that apply)
The amount of time I can spend with clients is too short to discuss pregnancy options
I don’t know about adoption resources or services in our area to use for referrals
I don’t know about other supportive community resources to use for referrals
We don’t have adoption resources in our area
We don’t have other community resources in our area
More staff need the training, but my supervisor/agency won’t allow them the time to attend
My supervisor/agency discourages me from using the guidelines in my work with clients
Clients with unintended pregnancies are too upset to discuss their options immediately after receiving their pregnancy results
Other (specify) _____________________________________________________________
No barriers have been encountered
To what extent would you say the Infant Adoption Awareness Training Program was helpful in improving your knowledge and ability to refer clients to the following resources...?
|
Very Helpful |
Somewhat Helpful |
Not At All Helpful |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Please enter any comments below regarding how you have used or plan to use the Infant Adoption Awareness Training in your work with clients.
_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Thank you for your participation in this survey.
IAATP
Cross-Site Evaluation Trainee Follow-Up Survey (JBA-E)
File Type | application/msword |
File Title | DRAFT: |
Author | Keating |
Last Modified By | Keating |
File Modified | 2007-09-21 |
File Created | 2007-09-20 |