8 CQI Practicum Completion Survey

OMB No: 0906-0084

Expiration date: 02/28/2027

CQI Practicum (Completion) Survey

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. The OMB control number for this project is 0906-0084 and is valid until 02/28/2027. This information collection is voluntary. All responses will be aggregated and respondents will remain confidential. Public reporting burden for this collection of information is estimated to average .12 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 Information Collection Clearance Officer, 5600 Fishers Lane, Room 14N39, Rockville, Maryland, 20857 or paperwork@hrsa.gov.

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. How supportive was the CQI Practicum in helping you reach this goal/these goals? [Insert goals that teams identified on their application]

   1. Very supportive

   2. Supportive

   3. Mildly supportive

   4. The CQI Practicum did not support us in reaching our goals

6. [If mildly or not at all supportive] Please explain why the CQI Practicum did not support your team in meeting this goal. [Open text]

7. When were you MOST engaged in the CQI Practicum?

   1. Main virtual sessions

   2. Breakouts during virtual sessions

   3. Team coaching calls

   4. Other, please explain: _____

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, I’ve experienced barriers

   2. No, I’ve not experienced any barriers

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

10. Please rate your agreement with the following statement: This CQI Practicum integrated diversity, equity, and inclusion into the content it provided.

    1. Strongly agree

    2. Agree

    3. Disagree

    4. Strongly disagree

11. To what extent did you see diversity, equity, and inclusion show up in the approach of the TA provided?

    1. To a great extent

    2. Somewhat

    3. Very little

    4. Not at all

12. Please comment with any suggestions for how we can improve our technical assistance to more intentionally integrate diversity, equity, and inclusion.

13. As we work to improve our CQI Practicums, would you be willing to speak with us if we wanted to follow up on some of the feedback you provided (we would contact you via email)?

    1. Yes, I would be willing to speak with you.

    2. No, I would prefer not to.

14. [If yes] Please provide your email [Open text]

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

1. Which, if any, of these resources from the practicum do you plan to use in your work? [Multi-select]

   1. Resource 1

   2. Resource 2

   3. Resource 3

   4. Resource 4

   5. Resource 5

   6. Other, please explain: ____

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. [If yes] 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

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

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