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pdfSHORT-TERM TRAINING
AND TECHNICAL
ASSISTANCE FEEDBACK
OMB Control Number: 0970-0519
Expiration Date: 05/31/2020
Form
In order to help the National Human Trafficking Training and Technical Assistance Center (NHTTAC) better serve the field, we are
reaching out to obtain your feedback. We will protect the privacy of your information in accordance with the Federal Privacy Act,
and we will protect the confidentiality of your responses using procedures we have in place, including reporting all information in
aggregate to avoid identifying information. Only members of the NHTTAC Evaluation Team have access to information that could
identify respondents. If you have any questions about this survey or the evaluation, please contact NHTTACEval@icf.com.
Please provide the information below to create an anonymous ID:
Birth Month
(insert just the month
for your date of birth,
example: 08 for August)
First letter of first name
(example: S for Sara)
First letter of your middle name
(example: M for Maria)
T/TA:
DATES(S):
FACILITATOR(S):
Please indicate how well the technical assistance met each stated objective.
OVERALL OBJECTIVES
Poor
Fair
Good
Excellent
1.
[Insert objective 1].
1
2
3
4
2.
[Insert objective 2].
1
2
3
4
3.
[Insert objective 3].
1
2
3
4
4.
[Insert objective 4].
1
2
3
4
5.
[Insert objective 5].
1
2
3
4
Please indicate the extent to which you agree or disagree with the following statements.
FACILITATOR 1:
Strongly
Disagree
1
Disagree
Agree
2
3
Strongly
Agree
4
Not Applicable
6.
The facilitator’s knowledge and expertise of this
presenter were appropriate for this technical assistance.
7.
The facilitator delivered the content of the technical
assistance effectively.
1
2
3
4
NA
8.
The facilitator responded well to questions and
comments.
1
2
3
4
NA
9.
The facilitator created a respectful environment for
participants.
1
2
3
4
NA
1
2
3
4
NA
10. The facilitator encouraged and initiated helpful
discussions.
NA
PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13) STATEMENT OF PUBLIC BURDEN: The purpose of this information
collection is to enable NHTTAC to collect recipient and stakeholder feedback to improve NHTTAC’s T/TA service delivery. Public reporting
burden for this collection of information is estimated to average 0.167 hours per respondent, including the time for reviewing instructions,
gathering and maintaining the data needed, and reviewing the collection of information. This is a voluntary collection of information. An
agency may not conduct or sponsor, and a person is not required to respond to, a collection of information subject to the requirements of the
Paperwork Reduction Act of 1995, unless it displays a currently valid OMB control number. If you have any comments on this collection of
information, please contact the NHTTAC Evaluation Team at NHTTACEval@icf.com or 9300 Lee Highway, Fairfax, VA 22031.
SHORT-TERM TRAINING
AND TECHNICAL
ASSISTANCE FEEDBACK
OMB Control Number: 0970-0519
Expiration Date: 05/31/2020
Form
Strongly
Disagree
Disagree
Agree
Strongly
Agree
Not Applicable
1
2
3
4
NA
12. The facilitator delivered the content of the technical
assistance effectively.
1
2
3
4
NA
13. The facilitator responded well to questions and
comments.
1
2
3
4
NA
14. The facilitator created a respectful environment for
participants.
1
2
3
4
NA
15. The facilitator encouraged and initiated helpful
discussions.
1
2
3
4
NA
Strongly
Disagree
Disagree
Agree
Strongly
Agree
Not Applicable
16. The technical assistance addressed the critical issues
related to the topic(s).
1
2
3
4
NA
17. The time allotted was adequate for the scope of
material.
1
2
3
4
NA
18. The technical assistance was well organized and clear.
1
2
3
4
NA
19. The technical assistance increased my knowledge
related to the topic(s).
1
2
3
4
NA
20. The technical assistance was trauma-informed.
1
2
3
4
NA
21. The technical assistance was survivor-informed.
1
2
3
4
NA
22. The technical assistance was grounded in current
evidence-based or promising practices.
1
2
3
4
NA
23. The technical assistance was grounded in a
multidisciplinary approach to addressing human
trafficking.
1
2
3
4
NA
24. The technical assistance reflected a public health
approach to addressing human trafficking.
1
2
3
4
NA
25. The technical assistance increased my practical skills
related to the topic(s).
1
2
3
4
NA
26. This technical assistance met my educational needs.
1
2
3
4
NA
27. This technical assistance met my professional needs.
1
2
3
4
NA
28. I will be able to apply what I learned in my work.
1
2
3
4
NA
29. The technical assistance improved my ability to serve
people who are currently being trafficked, at risk of
trafficking, or have been trafficked.
1
2
3
4
NA
30. I will share what I learned with my colleagues.
1
2
3
4
NA
FACILITATOR 2:
11. The facilitator’s knowledge and expertise of this
presenter were appropriate for this technical assistance.
OVERALL FEEDBACK
PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13) STATEMENT OF PUBLIC BURDEN: The purpose of this information
collection is to enable NHTTAC to collect recipient and stakeholder feedback to improve NHTTAC’s T/TA service delivery. Public reporting
burden for this collection of information is estimated to average 0.167 hours per respondent, including the time for reviewing instructions,
gathering and maintaining the data needed, and reviewing the collection of information. This is a voluntary collection of information. An
agency may not conduct or sponsor, and a person is not required to respond to, a collection of information subject to the requirements of the
Paperwork Reduction Act of 1995, unless it displays a currently valid OMB control number. If you have any comments on this collection of
information, please contact the NHTTAC Evaluation Team at NHTTACEval@icf.com or 9300 Lee Highway, Fairfax, VA 22031.
SHORT-TERM TRAINING
AND TECHNICAL
ASSISTANCE FEEDBACK
OMB Control Number: 0970-0519
Expiration Date: 05/31/2020
Form
Please select the number that best represents your rating of this technical assistance for each of the following questions.
31. How satisfied were you with your overall NHTTAC experience?
1
2
3
4
Very Dissatisfied
Dissatisfied
Satisfied
Very Satisfied
32. Please rate the overall quality of this technical assistance.
1
2
3
4
Poor
Fair
Good
Excellent
33. How well did this technical assistance meet your expectations?
1
Far Below My
Expectations
2
Did Not Meet My
Expectations
3
Met My
Expectations
4
Exceeded My
Expectations
34. How useful was the technical assistance information to your work?
1
2
3
4
Not Useful
Somewhat Useful
Useful
Very Useful
35. How prepared do you feel in implementing what you learned from this technical assistance in your daily work?
1
Not At All Prepared
2
Somewhat
Unprepared
3
4
Somewhat Prepared
Very Prepared
36. As a result of participating in this technical assistance, do you plan to do any of the following? (Mark all that apply.)
□ Change my management/leadership or
□ Expand services or types of services
interpersonal communication style
□ Begin a new project or initiative
□ Further develop skills and knowledge about serving
□ Develop/strengthen collaborative or strategic
people who are currently being trafficked, at risk of
relationships
trafficking, or have been trafficked
□ Network with other participants
□ Write grants/fundraise/identify new funding
□ Share materials with colleagues
resources
□ Provide information to clients/families/youth
□ Advocate or meet with leadership of my
□ Train/educate others in content/skills learned
organization to develop/enhance vision, mission, or
□ Raise public awareness/advocacy/outreach
strategic plan
activities offered to people who are currently being
□ Advocate or meet with leadership of my
trafficked, at risk of trafficking, or have been
organization to develop/enact policy changes at my
trafficked
organization
□ Refer colleagues to NHTTAC events/resources
□ Improve programs/practices
□ Conduct research
□ Improve technology/websites/infrastructure
□ Strengthen evaluation or needs assessment
□ Integrate victim-centered, survivor-informed
activities
strategies
PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13) STATEMENT OF PUBLIC BURDEN: The purpose of this information
collection is to enable NHTTAC to collect recipient and stakeholder feedback to improve NHTTAC’s T/TA service delivery. Public reporting
burden for this collection of information is estimated to average 0.167 hours per respondent, including the time for reviewing instructions,
gathering and maintaining the data needed, and reviewing the collection of information. This is a voluntary collection of information. An
agency may not conduct or sponsor, and a person is not required to respond to, a collection of information subject to the requirements of the
Paperwork Reduction Act of 1995, unless it displays a currently valid OMB control number. If you have any comments on this collection of
information, please contact the NHTTAC Evaluation Team at NHTTACEval@icf.com or 9300 Lee Highway, Fairfax, VA 22031.
SHORT-TERM TRAINING
AND TECHNICAL
ASSISTANCE FEEDBACK
OMB Control Number: 0970-0519
Expiration Date: 05/31/2020
Form
□
□
□
Improve identification and reporting
methods for trafficking
Take additional training on human trafficking
Other (please specify):
37. Of the barriers listed below, which do you believe will be a significant challenge to performing the activities you selected in
the previous question? (Mark all that apply.)
□
□
□
□
□
□
□
□
□
□
Lack of senior leadership support
Lack of frontline support and accountability
Continuous turnover
Shortages of key personnel
Competing priorities
Inaccessible research and/or information
Lack of urgency
Lack of shared responsibility across organizational
collaboration
Lack of information sharing among organizations
Lack of time to implement changes
□
□
□
□
□
□
□
38. Would you recommend NHTTAC to others to receive T/TA?
Difficulty in establishing and/or maintaining a
multi-disciplinary team
Need for partnership building with other
organizations
Variation in mission and regulatory frameworks
when partnering with other organizations
Lack of information and/or data sharing among
organizations
Lack of time to implement changes
Lack of training for staff in how to implement
change
Other (please explain):
□ Yes
□ No
39. Please list any professional goals you have achieved through this T/TA.
40. How will this assistance help your agency in responding to human trafficking?
41. What aspects of the assistance were most helpful and why?
42. What could NHTTAC do differently to improve similar T/TA requests in the future?
PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13) STATEMENT OF PUBLIC BURDEN: The purpose of this information
collection is to enable NHTTAC to collect recipient and stakeholder feedback to improve NHTTAC’s T/TA service delivery. Public reporting
burden for this collection of information is estimated to average 0.167 hours per respondent, including the time for reviewing instructions,
gathering and maintaining the data needed, and reviewing the collection of information. This is a voluntary collection of information. An
agency may not conduct or sponsor, and a person is not required to respond to, a collection of information subject to the requirements of the
Paperwork Reduction Act of 1995, unless it displays a currently valid OMB control number. If you have any comments on this collection of
information, please contact the NHTTAC Evaluation Team at NHTTACEval@icf.com or 9300 Lee Highway, Fairfax, VA 22031.
SHORT-TERM TRAINING
AND TECHNICAL
ASSISTANCE FEEDBACK
OMB Control Number: 0970-0519
Expiration Date: 05/31/2020
Form
43. Do you have any other comments or suggestions?
44. Which of the following best describes the organization in which you work? (Mark all that apply.)
□
□
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□
□
□
□
□
□
□
□
□
□
□
□
Academic institution
Anti-trafficking organization
Business/For-profit organization
Coalition/Multidisciplinary team/Task force
Federal government
Faith-based organization
State and local government
Nonprofit/Community-based organization
OTIP grantee
Self-employed
Survivor-led organization
Tribal government
Union/Worker advocacy organization
Victim service provider
Other (please specify):
45. Is your organization responsible for working with people who are currently being trafficked or have been trafficked?
□ Yes
□ No
46. Which of the following best describes your professional capacity or types of services you provide? (Mark all that apply.)
□
□
□
□
□
□
□
□
Behavioral health professional (e.g., psychologist,
psychiatrist, mental health/substance use counselor)
Child welfare (e.g., state agency staff, child welfare
contractor, nonprofit personnel)
Corrections-based services (e.g., parole, probation)
Criminal justice (e.g., law enforcement, prosecutor,
probation, court, forensic interviewer)
Educator (e.g., teacher, professor, school
administrator)
Health care (e.g., physician, physician assistant,
nurse practitioner, dentist, nurse, pharmacist)
Housing (e.g., case worker, shelter director, public
housing authority agencies)
□
□
□
□
□
Legal (e.g., immigration, civil and/or rights-based
attorney and/or paralegal, clinic)
Public health (e.g., licensure board, health
department staff, health care executive, community
health workers)
Social worker (e.g., case manager, school
counselor, supervisor, administrator)
Survivor empowerment, mentoring, or peer-to-peer
Violence prevention (e.g., child abuse and neglect,
elder abuse, domestic violence, sexual violence,
youth violence)
Other (please specify):
47. Which of the following best describes the number of years of experience you have in your current field of work? (Mark one.)
□ Less than 3 years
□ 3 to 5 years
□ 6 to 10 years
□ More than 10 years
48. Which of the following best describes your primary role in your current position?
□ Direct delivery/frontline staff
□ Management
□ Other (please specify):
□ Consultant/Trainer
□ Volunteer
□ Administration
□ Peer Educator
PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13) STATEMENT OF PUBLIC BURDEN: The purpose of this information
collection is to enable NHTTAC to collect recipient and stakeholder feedback to improve NHTTAC’s T/TA service delivery. Public reporting
burden for this collection of information is estimated to average 0.167 hours per respondent, including the time for reviewing instructions,
gathering and maintaining the data needed, and reviewing the collection of information. This is a voluntary collection of information. An
agency may not conduct or sponsor, and a person is not required to respond to, a collection of information subject to the requirements of the
Paperwork Reduction Act of 1995, unless it displays a currently valid OMB control number. If you have any comments on this collection of
information, please contact the NHTTAC Evaluation Team at NHTTACEval@icf.com or 9300 Lee Highway, Fairfax, VA 22031.
SHORT-TERM TRAINING
AND TECHNICAL
ASSISTANCE FEEDBACK
OMB Control Number: 0970-0519
Expiration Date: 05/31/2020
Form
49. In your professional capacity, how frequently do you come into contact with a person who is currently being trafficked, at
risk of being trafficked, or has been trafficked?
1
2
3
4
Never
Occasionally
Frequently
Daily
50. Which of the following best describes your geographic population? (Mark all that apply.)
□
□
□
□
National
State (please specify):
Tribal
International (please specify country):
□ Local
□ Urban
□ Rural
□ Suburban
51. Please select any of the following populations you currently work with in a professional capacity (Mark all that apply.)
□
□
□
□
□
Human trafficking
□ Commercial sexual exploitation of
children
□ Sex trafficking
□ Adults
□ Minors
□ Labor trafficking
□ Adults
□ Minors
Children/youth
□ Out of home/Foster care/Kinship care
□ Juvenile justice
□ Runaway/Homeless youth
People with disabilities
Deaf/Hearing impaired
Elderly
□
□
□
□
□
□
□
□
□
Lesbian, gay, bisexual, transgender, and
questioning
Foreign nationals (migrant workers, undocumented
immigrants, refugees)
People with low incomes
Racial and ethnic minorities
□ American Indian or Alaska Native
□ Asian
□ Black or African American
□ Native Hawaii or other Pacific Islander
□ White
□ Hispanic or Latino ethnicity
History of substance use
Domestic and dating violence
Gang-related crime
Sexual abuse/Violence
Other (please specify):
52. What is your race? (Mark all that apply.)
□
□
□
□
□
□
American Indian or Alaska Native
Asian
Black or African American
Native Hawaii or other Pacific Islander
White
Other (please specify):
53. What is your ethnicity? (Mark all that apply.)
□
□
□
Hispanic or Latino
Middle Eastern or North African
Other (please specify):
PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13) STATEMENT OF PUBLIC BURDEN: The purpose of this information
collection is to enable NHTTAC to collect recipient and stakeholder feedback to improve NHTTAC’s T/TA service delivery. Public reporting
burden for this collection of information is estimated to average 0.167 hours per respondent, including the time for reviewing instructions,
gathering and maintaining the data needed, and reviewing the collection of information. This is a voluntary collection of information. An
agency may not conduct or sponsor, and a person is not required to respond to, a collection of information subject to the requirements of the
Paperwork Reduction Act of 1995, unless it displays a currently valid OMB control number. If you have any comments on this collection of
information, please contact the NHTTAC Evaluation Team at NHTTACEval@icf.com or 9300 Lee Highway, Fairfax, VA 22031.
SHORT-TERM TRAINING
AND TECHNICAL
ASSISTANCE FEEDBACK
OMB Control Number: 0970-0519
Expiration Date: 05/31/2020
Form
54. What is your gender? (Mark all that apply.)
□
□
□
□
Male
Female
Transgender
Other (please specify):
Thank you for taking the time to complete this form and helping to improve NHTTAC activities.
PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13) STATEMENT OF PUBLIC BURDEN: The purpose of this information
collection is to enable NHTTAC to collect recipient and stakeholder feedback to improve NHTTAC’s T/TA service delivery. Public reporting
burden for this collection of information is estimated to average 0.167 hours per respondent, including the time for reviewing instructions,
gathering and maintaining the data needed, and reviewing the collection of information. This is a voluntary collection of information. An
agency may not conduct or sponsor, and a person is not required to respond to, a collection of information subject to the requirements of the
Paperwork Reduction Act of 1995, unless it displays a currently valid OMB control number. If you have any comments on this collection of
information, please contact the NHTTAC Evaluation Team at NHTTACEval@icf.com or 9300 Lee Highway, Fairfax, VA 22031.
File Type | application/pdf |
File Title | 10 - Short Term TTA Feedback.docx |
Author | Field, Michael |
File Modified | 2020-03-20 |
File Created | 2020-03-20 |