Home Visiting Training Survey

The Lane County Home Visiting Work Group is hoping to provide some training opportunities this year and next. To assist us in our planning efforts, please complete this survey and return no later than March 5th, 2010. Thank you.

1. Please enter your first and last name:

Please enter your first and last name:

2. Please enter your organization:

Please enter your organization:

3. Please enter your email address:

Please enter your email address:

4. Are you and/or your staff interested in attending home visiting trainings? If yes or not sure, continue to #5. If no, please skip to #10.

Are you and/or your staff interested in attending home visiting trainings? If yes or not sure, continue to #5. If no, please skip to #10. Yes

Not sure/don’t know

Comments

5. How many people would your organization anticipate sending?

How many people would your organization anticipate sending?

6. What type of training would you most prefer?

What type of training would you most prefer? full day symposium

half day seminar

series of one to two hour trainings

Other (please specify)

7. What day of the week is preferable for staff to attend? Please indicate your first and second choice:

	First Choice	Second Choice
Monday	What day of the week is preferable for staff to attend? Please indicate your first and second choice: Monday First Choice	Monday Second Choice
Tuesday	Tuesday First Choice	Tuesday Second Choice
Wednesday	Wednesday First Choice	Wednesday Second Choice
Thursday	Thursday First Choice	Thursday Second Choice
Friday	Friday First Choice	Friday Second Choice
Saturday	Saturday First Choice	Saturday Second Choice

8. What time of day is preferable for staff? Please indicate your first and second choice:

	First Choice	Second Choice
Morning	What time of day is preferable for staff? Please indicate your first and second choice: Morning First Choice	Morning Second Choice
Lunch time	Lunch time First Choice	Lunch time Second Choice
Afternoon	Afternoon First Choice	Afternoon Second Choice
Evening	Evening First Choice	Evening Second Choice

Other (please specify)

9. Please rate your interest in the following training topics:

	Very Interested	Somewhat Interested	Not Very Interested	Not Interested At All	N/A
Basic home visiting training for new staff	Please rate your interest in the following training topics: Basic home visiting training for new staff Very Interested	Basic home visiting training for new staff Somewhat Interested	Basic home visiting training for new staff Not Very Interested	Basic home visiting training for new staff Not Interested At All	Basic home visiting training for new staff N/A
Breastfeeding	Breastfeeding Very Interested	Breastfeeding Somewhat Interested	Breastfeeding Not Very Interested	Breastfeeding Not Interested At All	Breastfeeding N/A
Children with special needs and their families	Children with special needs and their families Very Interested	Children with special needs and their families Somewhat Interested	Children with special needs and their families Not Very Interested	Children with special needs and their families Not Interested At All	Children with special needs and their families N/A
Culture of poverty	Culture of poverty Very Interested	Culture of poverty Somewhat Interested	Culture of poverty Not Very Interested	Culture of poverty Not Interested At All	Culture of poverty N/A
Domestic violence	Domestic violence Very Interested	Domestic violence Somewhat Interested	Domestic violence Not Very Interested	Domestic violence Not Interested At All	Domestic violence N/A
Diversity issues	Diversity issues Very Interested	Diversity issues Somewhat Interested	Diversity issues Not Very Interested	Diversity issues Not Interested At All	Diversity issues N/A
Early literacy	Early literacy Very Interested	Early literacy Somewhat Interested	Early literacy Not Very Interested	Early literacy Not Interested At All	Early literacy N/A
Employment and job training for families	Employment and job training for families Very Interested	Employment and job training for families Somewhat Interested	Employment and job training for families Not Very Interested	Employment and job training for families Not Interested At All	Employment and job training for families N/A
Helping families find quality child care	Helping families find quality child care Very Interested	Helping families find quality child care Somewhat Interested	Helping families find quality child care Not Very Interested	Helping families find quality child care Not Interested At All	Helping families find quality child care N/A
Home visiting curricula	Home visiting curricula Very Interested	Home visiting curricula Somewhat Interested	Home visiting curricula Not Very Interested	Home visiting curricula Not Interested At All	Home visiting curricula N/A
Home visiting staff safety	Home visiting staff safety Very Interested	Home visiting staff safety Somewhat Interested	Home visiting staff safety Not Very Interested	Home visiting staff safety Not Interested At All	Home visiting staff safety N/A
Infants exposed to alcohol, tobacco and other drugs	Infants exposed to alcohol, tobacco and other drugs Very Interested	Infants exposed to alcohol, tobacco and other drugs Somewhat Interested	Infants exposed to alcohol, tobacco and other drugs Not Very Interested	Infants exposed to alcohol, tobacco and other drugs Not Interested At All	Infants exposed to alcohol, tobacco and other drugs N/A
Infant mental health	Infant mental health Very Interested	Infant mental health Somewhat Interested	Infant mental health Not Very Interested	Infant mental health Not Interested At All	Infant mental health N/A
Infant/toddler safety	Infant/toddler safety Very Interested	Infant/toddler safety Somewhat Interested	Infant/toddler safety Not Very Interested	Infant/toddler safety Not Interested At All	Infant/toddler safety N/A
Information and referral resources	Information and referral resources Very Interested	Information and referral resources Somewhat Interested	Information and referral resources Not Very Interested	Information and referral resources Not Interested At All	Information and referral resources N/A
Liability/legal issues	Liability/legal issues Very Interested	Liability/legal issues Somewhat Interested	Liability/legal issues Not Very Interested	Liability/legal issues Not Interested At All	Liability/legal issues N/A
Motivational interviewing	Motivational interviewing Very Interested	Motivational interviewing Somewhat Interested	Motivational interviewing Not Very Interested	Motivational interviewing Not Interested At All	Motivational interviewing N/A
Perinatal Mood Disorders	Perinatal Mood Disorders Very Interested	Perinatal Mood Disorders Somewhat Interested	Perinatal Mood Disorders Not Very Interested	Perinatal Mood Disorders Not Interested At All	Perinatal Mood Disorders N/A
Prenatal home visits	Prenatal home visits Very Interested	Prenatal home visits Somewhat Interested	Prenatal home visits Not Very Interested	Prenatal home visits Not Interested At All	Prenatal home visits N/A
Reflective supervision	Reflective supervision Very Interested	Reflective supervision Somewhat Interested	Reflective supervision Not Very Interested	Reflective supervision Not Interested At All	Reflective supervision N/A
Working with families with substance abuse and addiction issues	Working with families with substance abuse and addiction issues Very Interested	Working with families with substance abuse and addiction issues Somewhat Interested	Working with families with substance abuse and addiction issues Not Very Interested	Working with families with substance abuse and addiction issues Not Interested At All	Working with families with substance abuse and addiction issues N/A
Working with fathers	Working with fathers Very Interested	Working with fathers Somewhat Interested	Working with fathers Not Very Interested	Working with fathers Not Interested At All	Working with fathers N/A
Working with interpreters in the home	Working with interpreters in the home Very Interested	Working with interpreters in the home Somewhat Interested	Working with interpreters in the home Not Very Interested	Working with interpreters in the home Not Interested At All	Working with interpreters in the home N/A
Working with victims of childhood abuse	Working with victims of childhood abuse Very Interested	Working with victims of childhood abuse Somewhat Interested	Working with victims of childhood abuse Not Very Interested	Working with victims of childhood abuse Not Interested At All	Working with victims of childhood abuse N/A

Other (please specify)

10. Other comments/suggestions:

Other comments/suggestions:

Home Visiting Training Survey
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1. Default Section

1. Please enter your first and last name:

2. Please enter your organization:

3. Please enter your email address:

4. Are you and/or your staff interested in attending home visiting trainings? If yes or not sure, continue to #5. If no, please skip to #10.

5. How many people would your organization anticipate sending?

6. What type of training would you most prefer?

7. What day of the week is preferable for staff to attend? Please indicate your first and second choice:

8. What time of day is preferable for staff? Please indicate your first and second choice:

9. Please rate your interest in the following training topics:

10. Other comments/suggestions:

Home Visiting Training SurveyExit this survey

1. Default Section

1. Please enter your first and last name:

2. Please enter your organization:

3. Please enter your email address:

4. Are you and/or your staff interested in attending home visiting trainings? If yes or not sure, continue to #5. If no, please skip to #10.

5. How many people would your organization anticipate sending?

6. What type of training would you most prefer?

7. What day of the week is preferable for staff to attend? Please indicate your first and second choice:

8. What time of day is preferable for staff? Please indicate your first and second choice:

9. Please rate your interest in the following training topics:

10. Other comments/suggestions:

Home Visiting Training Survey
Exit this survey