Ontario P.I.E.C.E.S. Educator Development Program Evaluation Survey

Question Title

* 1. Educator Information (required):
The following information is required in order to prepare and send an Educator Contract to you.

First Name

Last Name

Organization Name:

Address:

City/Town

Postal Code

Email Address:

Phone Number

Question Title

* 2. Select the LHIN Region you support (select one)

1 - Erie St.Clair

2 - Southwest

3 - Waterloo-Wellington

4 - Hamilton Niagara Haldimand Norfolk

5 - Central West

6 - Mississauga HaltonHamilton Niagara Haldimand Brant

7 - Toronto Central

8 - Central

9 - Central East

10 - Southeast

11 - Champlain

12 - North Simcoe Muskoka

13 - Northeast

14 - Northwest

Question Title

* 3. Are you planning on facilitating (co-facilitating) a 16-hour P.I.E.C.E.S. Program in your region in 2017-2018?

Yes

If yes, please indicate the month and year you will be scheduling it::

Question Title

* 4. Considering the work that you do, please select the appropriate number for the statements below- where "0" indicates the lowest and "10" indicates the highest rating.

	0	1	2	3	4	5	6	7	8	9	10
Rate your knowledge of the P.I.E.C.E.S. TEAM approach using the 3-Question template.	Rate your knowledge of the P.I.E.C.E.S. TEAM approach using the 3-Question template. 0	Rate your knowledge of the P.I.E.C.E.S. TEAM approach using the 3-Question template. 1	Rate your knowledge of the P.I.E.C.E.S. TEAM approach using the 3-Question template. 2	Rate your knowledge of the P.I.E.C.E.S. TEAM approach using the 3-Question template. 3	Rate your knowledge of the P.I.E.C.E.S. TEAM approach using the 3-Question template. 4	Rate your knowledge of the P.I.E.C.E.S. TEAM approach using the 3-Question template. 5	Rate your knowledge of the P.I.E.C.E.S. TEAM approach using the 3-Question template. 6	Rate your knowledge of the P.I.E.C.E.S. TEAM approach using the 3-Question template. 7	Rate your knowledge of the P.I.E.C.E.S. TEAM approach using the 3-Question template. 8	Rate your knowledge of the P.I.E.C.E.S. TEAM approach using the 3-Question template. 9	Rate your knowledge of the P.I.E.C.E.S. TEAM approach using the 3-Question template. 10
How comfortable are you in using the P.I.E.C.E.S. TEAM approach in your individual clinical role?	How comfortable are you in using the P.I.E.C.E.S. TEAM approach in your individual clinical role? 0	How comfortable are you in using the P.I.E.C.E.S. TEAM approach in your individual clinical role? 1	How comfortable are you in using the P.I.E.C.E.S. TEAM approach in your individual clinical role? 2	How comfortable are you in using the P.I.E.C.E.S. TEAM approach in your individual clinical role? 3	How comfortable are you in using the P.I.E.C.E.S. TEAM approach in your individual clinical role? 4	How comfortable are you in using the P.I.E.C.E.S. TEAM approach in your individual clinical role? 5	How comfortable are you in using the P.I.E.C.E.S. TEAM approach in your individual clinical role? 6	How comfortable are you in using the P.I.E.C.E.S. TEAM approach in your individual clinical role? 7	How comfortable are you in using the P.I.E.C.E.S. TEAM approach in your individual clinical role? 8	How comfortable are you in using the P.I.E.C.E.S. TEAM approach in your individual clinical role? 9	How comfortable are you in using the P.I.E.C.E.S. TEAM approach in your individual clinical role? 10
How comfortable are you in the role as a P.I.E.C.E.S. Educator?	How comfortable are you in the role as a P.I.E.C.E.S. Educator? 0	How comfortable are you in the role as a P.I.E.C.E.S. Educator? 1	How comfortable are you in the role as a P.I.E.C.E.S. Educator? 2	How comfortable are you in the role as a P.I.E.C.E.S. Educator? 3	How comfortable are you in the role as a P.I.E.C.E.S. Educator? 4	How comfortable are you in the role as a P.I.E.C.E.S. Educator? 5	How comfortable are you in the role as a P.I.E.C.E.S. Educator? 6	How comfortable are you in the role as a P.I.E.C.E.S. Educator? 7	How comfortable are you in the role as a P.I.E.C.E.S. Educator? 8	How comfortable are you in the role as a P.I.E.C.E.S. Educator? 9	How comfortable are you in the role as a P.I.E.C.E.S. Educator? 10
To what extent do you coach others in their day-to-day application of the P.I.E.C.E.S. TEAM approach?	To what extent do you coach others in their day-to-day application of the P.I.E.C.E.S. TEAM approach? 0	To what extent do you coach others in their day-to-day application of the P.I.E.C.E.S. TEAM approach? 1	To what extent do you coach others in their day-to-day application of the P.I.E.C.E.S. TEAM approach? 2	To what extent do you coach others in their day-to-day application of the P.I.E.C.E.S. TEAM approach? 3	To what extent do you coach others in their day-to-day application of the P.I.E.C.E.S. TEAM approach? 4	To what extent do you coach others in their day-to-day application of the P.I.E.C.E.S. TEAM approach? 5	To what extent do you coach others in their day-to-day application of the P.I.E.C.E.S. TEAM approach? 6	To what extent do you coach others in their day-to-day application of the P.I.E.C.E.S. TEAM approach? 7	To what extent do you coach others in their day-to-day application of the P.I.E.C.E.S. TEAM approach? 8	To what extent do you coach others in their day-to-day application of the P.I.E.C.E.S. TEAM approach? 9	To what extent do you coach others in their day-to-day application of the P.I.E.C.E.S. TEAM approach? 10
I believe this workshop will impact sustainable improvements in quality care with individuals with complex physical, cognitive and mental health care needs.	I believe this workshop will impact sustainable improvements in quality care with individuals with complex physical, cognitive and mental health care needs. 0	I believe this workshop will impact sustainable improvements in quality care with individuals with complex physical, cognitive and mental health care needs. 1	I believe this workshop will impact sustainable improvements in quality care with individuals with complex physical, cognitive and mental health care needs. 2	I believe this workshop will impact sustainable improvements in quality care with individuals with complex physical, cognitive and mental health care needs. 3	I believe this workshop will impact sustainable improvements in quality care with individuals with complex physical, cognitive and mental health care needs. 4	I believe this workshop will impact sustainable improvements in quality care with individuals with complex physical, cognitive and mental health care needs. 5	I believe this workshop will impact sustainable improvements in quality care with individuals with complex physical, cognitive and mental health care needs. 6	I believe this workshop will impact sustainable improvements in quality care with individuals with complex physical, cognitive and mental health care needs. 7	I believe this workshop will impact sustainable improvements in quality care with individuals with complex physical, cognitive and mental health care needs. 8	I believe this workshop will impact sustainable improvements in quality care with individuals with complex physical, cognitive and mental health care needs. 9	I believe this workshop will impact sustainable improvements in quality care with individuals with complex physical, cognitive and mental health care needs. 10

Question Title

* 5. Please add any other needs that you have identified or other comments.

Thank you for completing this evaluation of the P.I.E.C.E.S. Educator Development Program!

Question Title

* 1. Educator Information (required):The following information is required in order to prepare and send an Educator Contract to you.

Question Title

* 2. Select the LHIN Region you support (select one)

Question Title

* 3. Are you planning on facilitating (co-facilitating) a 16-hour P.I.E.C.E.S. Program in your region in 2017-2018?

Question Title

* 4. Considering the work that you do, please select the appropriate number for the statements below- where "0" indicates the lowest and "10" indicates the highest rating.

Question Title

* 5. Please add any other needs that you have identified or other comments.

* 1. Educator Information (required):
The following information is required in order to prepare and send an Educator Contract to you.