10 Attachment J_CQI Practicum Completion Survey

OMB No: 0915-0212

Expiration date: 04/30/2024

CQI Practicum (Completion) Survey

Sent at the end of the CQI Practicum

Public Burden Statement: The purpose of this information collection request is to assess participant satisfaction with various training and TA activities offered through a contracted TA provider, the Education Development Center. 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. This data collection is voluntary. The OMB control number for this project is 0915-0212 and is valid until 04/30/2024. Public reporting burden for this collection of information is estimated to average .08 hours per response, including the time for reviewing instructions, searching existing data sources, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to HRSA Reports Clearance Officer, 5600 Fishers Lane, Room 14N136B, Rockville, Maryland, 20857.

1. Overall, how satisfied were you with CQI Practicum?

   1. Extremely satisfied

   2. Satisfied

   3. Dissatisfied

   4. Extremely dissatisfied

2. [If chosen “Dissatisfied” or “Extremely dissatisfied”] Please explain why you were dissatisfied with the CQI Practicum: [Open text]

3. On a scale from 1-5, please rate how effective you think the experiences provided by this CQI Practicum were at developing your skills in CQI?

   1. 1 (Not effective)

   2. 2

   3. 3

   4. 4

   5. 5 (Very effective)

4. Below are the CQI Practicum objectives. Please indicate the extent to which you agree that these objectives were met: [Matrix]

   1. Establish SMART aims for an appropriately scoped quality improvement project

   2. Create and use measures to track progress towards achievement of aims

   3. Identify potential changes to test by deploying different quality improvement tools

   4. Run multiple “ramps” of Plan, Do, Study, Act (PDSA) cycles

   5. Use run charts to track results

   6. Design a process to sustain improvements

   7. Share the story of your improvement project through the development of a Key Driver Diagram and annotated run charts

5. Think back to your expectations for the CQI Practicum when you first signed up for it. What were your expectations? Did we meet those expectations? [Open text]

6. When were you MOST engaged in the CQI Practicum? [Open text]

7. When were you LEAST engaged in the CQI Practicum? [Open text]

8. Did you experience any barriers to participating in the CQI Practicum, including participating in the coaching calls, virtual sessions, or on the MALL?

   1. Yes

   2. No

   3. Maybe

9. [If yes or maybe] Please describe the barriers you experienced that kept you from participating fully in the CQI Practicum: [Open text]

10. We are particularly interested in whether our technical assistance is provided in a culturally appropriate manner. Please rate your agreement with the following statement: This CQI Practicum was provided in a culturally responsive manner (respectful of individual beliefs, language, perspectives, and needs)

1. Strongly agree

2. Agree

3. Neither agree nor disagree

4. Disagree

For awardees: A section of the survey only added to surveys of awardee participants

1. Are there resources or tools from the practicum that you plan to use in your work? (i.e., list of tools here)

   1. Yes

   2. No

   3. Maybe

1a.[If yes/maybe] Please explain: [Open text]

1b.[If no] Why not?

2. Will your participation in the practicum influence how you lead CQI efforts in your home visiting program moving forward?

1. Yes

2. No

3. Maybe

3. [If yes/maybe] How so? [Open text]

4. [If no] Why not? [Open text]

For LIAs: A section of the survey only added to surveys of LIA participants

1. Will your participation in the practicum inform your next CQI project?

   1. Yes

   2. No

   3. Maybe

2. [If yes/maybe] How so? [Open text]

3. [If no] Why not? [Open text]