SurveyMonkey Powered Online Survey

1. Mandatory Reporting and You: Elder Abuse In Georgia

We are pleased that you participated in a Foothills AHEC Healthtecdl educational program. Please take the time to fill out this evaluation survey, so that we can improve future programs.

For continuing education certificate, and/or certificate of completion, an evaluation is required. Continuing education certificates will be mailed to the participants.

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* 1. Please provide your name and email address so that we may identify registrants that complete the evaluation survey for continuing education certificates and/or certificates of completion. We will send reminder emails to those that do not complete the evaluation survey.

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* 2. Please indicate your professional degree.

MSW

LPC

MFT

LMSW

Licensed Practical Nurses

Certified Nursing Assistants

Medical Assistants

Nursing Home Administrator

Behavior Health Personnel

Occupation Therapist

Occupaton Therapist Assistant

Physical Therapist

Physical Therapist Assistant

Other (please specify)

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* 3. Name of Employer and County of Employment

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* 4. If you want to received a continuing education certificate and checked

Social Worker please provide the last 4 digits of your SSN. Please indicate if your are MSW/ MFT/ LPC/or Other.

PT/PTA please provide your license#

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* 5. Please provide the following information

If you check Behavioral Health Personnel, provide the name of your facility/agency

If you check student, provide the name of your school and area of study

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* 6. If you are a student, Please provide the name of your school and your area of study.

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* 7. Did you participate in the AHEC/Healthtecdl program from your organization's facilities?

Yes

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* 8. If yes, were there other individuals who viewed the presentation with you?

Yes

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* 9. If yes, number according to ethnicity and gender who viewed the presentation with you.

African-American

Asian

Caucasian

Hispanic/Latino

Male

Female

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* 10. If yes, please provide the names and email addresses of these people, so we may have a complete record of participants.

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* 11. Please rate the following aspects of the program content:

	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree
Activity met the stated objectives.	Activity met the stated objectives. Strongly Disagree	Activity met the stated objectives. Disagree	Activity met the stated objectives. Neutral	Activity met the stated objectives. Agree	Activity met the stated objectives. Strongly Agree
Provide data on the societal impact of elder abuse	Provide data on the societal impact of elder abuse Strongly Disagree	Provide data on the societal impact of elder abuse Disagree	Provide data on the societal impact of elder abuse Neutral	Provide data on the societal impact of elder abuse Agree	Provide data on the societal impact of elder abuse Strongly Agree
Identify the types of elder abuse	Identify the types of elder abuse Strongly Disagree	Identify the types of elder abuse Disagree	Identify the types of elder abuse Neutral	Identify the types of elder abuse Agree	Identify the types of elder abuse Strongly Agree
Recognize the indicators that abuse may be occurring.	Recognize the indicators that abuse may be occurring. Strongly Disagree	Recognize the indicators that abuse may be occurring. Disagree	Recognize the indicators that abuse may be occurring. Neutral	Recognize the indicators that abuse may be occurring. Agree	Recognize the indicators that abuse may be occurring. Strongly Agree
Provide instructions on making a report	Provide instructions on making a report Strongly Disagree	Provide instructions on making a report Disagree	Provide instructions on making a report Neutral	Provide instructions on making a report Agree	Provide instructions on making a report Strongly Agree
Provide data on prevention of elder abuse and data on intervention strategies for elder abuse,	Provide data on prevention of elder abuse and data on intervention strategies for elder abuse, Strongly Disagree	Provide data on prevention of elder abuse and data on intervention strategies for elder abuse, Disagree	Provide data on prevention of elder abuse and data on intervention strategies for elder abuse, Neutral	Provide data on prevention of elder abuse and data on intervention strategies for elder abuse, Agree	Provide data on prevention of elder abuse and data on intervention strategies for elder abuse, Strongly Agree

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* 12. Post Test Question #1

1. Give two examples of abuse.

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* 13. Post Test Question #2
Give two example of neglect.

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* 14. Post Test Question #3
Give two example of exploitation.

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* 15. Post Test Question #4
Give two example of indicators that abuse may occur

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* 16. Post Test Question #5
When can a report be made?

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* 17. Post Test Question #6
Where to report what types of abuse?

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* 18. Post Test Question #7
What type of Abuse should you report?

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* 19. Post Test question 8
Give examples of intervention strategies for elder abuse

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* 20. How Would you rate the quality of instruction?

	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree
Instructional materials were well organized.	Instructional materials were well organized. Strongly Disagree	Instructional materials were well organized. Disagree	Instructional materials were well organized. Neutral	Instructional materials were well organized. Agree	Instructional materials were well organized. Strongly Agree
Instructional methods illustrated the concepts well.	Instructional methods illustrated the concepts well. Strongly Disagree	Instructional methods illustrated the concepts well. Disagree	Instructional methods illustrated the concepts well. Neutral	Instructional methods illustrated the concepts well. Agree	Instructional methods illustrated the concepts well. Strongly Agree
If slides were presented, they will be useful reference.	If slides were presented, they will be useful reference. Strongly Disagree	If slides were presented, they will be useful reference. Disagree	If slides were presented, they will be useful reference. Neutral	If slides were presented, they will be useful reference. Agree	If slides were presented, they will be useful reference. Strongly Agree
References and resources provided will assist me.	References and resources provided will assist me. Strongly Disagree	References and resources provided will assist me. Disagree	References and resources provided will assist me. Neutral	References and resources provided will assist me. Agree	References and resources provided will assist me. Strongly Agree

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* 21. How would you rate the quality of the presentation?

	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree
Presenter was clear and to the point.	Presenter was clear and to the point. Strongly Disagree	Presenter was clear and to the point. Disagree	Presenter was clear and to the point. Neutral	Presenter was clear and to the point. Agree	Presenter was clear and to the point. Strongly Agree
Presenter demonstrated mastery of the topic.	Presenter demonstrated mastery of the topic. Strongly Disagree	Presenter demonstrated mastery of the topic. Disagree	Presenter demonstrated mastery of the topic. Neutral	Presenter demonstrated mastery of the topic. Agree	Presenter demonstrated mastery of the topic. Strongly Agree
Methods used to present the materials held my attention.	Methods used to present the materials held my attention. Strongly Disagree	Methods used to present the materials held my attention. Disagree	Methods used to present the materials held my attention. Neutral	Methods used to present the materials held my attention. Agree	Methods used to present the materials held my attention. Strongly Agree
Presenter was responsive to questions.	Presenter was responsive to questions. Strongly Disagree	Presenter was responsive to questions. Disagree	Presenter was responsive to questions. Neutral	Presenter was responsive to questions. Agree	Presenter was responsive to questions. Strongly Agree

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* 22. Based on this activity, do you plan to make changes to your practice/organization?

No, this does not apply to my practice/organization.

No, I already practice these guidelines.

maybe, not sure but thinking about it.

Yes, I plan to make changes.

Describe 1 to 2 things you intend to do or try differently.

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* 23. What one thing would you recommend that we change to improve content and/or presentation?

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* 24. Please list suggestions for future topics.

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* 25. Please rate the following aspects of the distance-based network.

	Very satisfied	Satisfied	Neutral	Dissatisfied	Very Dissatisfied
Ease of access to program.	Ease of access to program. Very satisfied	Ease of access to program. Satisfied	Ease of access to program. Neutral	Ease of access to program. Dissatisfied	Ease of access to program. Very Dissatisfied
Quality of the video/slides.	Quality of the video/slides. Very satisfied	Quality of the video/slides. Satisfied	Quality of the video/slides. Neutral	Quality of the video/slides. Dissatisfied	Quality of the video/slides. Very Dissatisfied
Quality of the audio.	Quality of the audio. Very satisfied	Quality of the audio. Satisfied	Quality of the audio. Neutral	Quality of the audio. Dissatisfied	Quality of the audio. Very Dissatisfied
Degree of interactivity.	Degree of interactivity. Very satisfied	Degree of interactivity. Satisfied	Degree of interactivity. Neutral	Degree of interactivity. Dissatisfied	Degree of interactivity. Very Dissatisfied

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* 26. Please describe any difficulties that you encountered in participating in the program from your location.

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* 27. What one thing would you recommend that we change to the distance based aspect of the program?

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* 28. How did you hear about this program?

Email/Foothills

Email/Mail/ Foothills

Email Healthtecdl

Other

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* 1. Please provide your name and email address so that we may identify registrants that complete the evaluation survey for continuing education certificates and/or certificates of completion. We will send reminder emails to those that do not complete the evaluation survey.

Question Title

* 2. Please indicate your professional degree.

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* 3. Name of Employer and County of Employment

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* 4. If you want to received a continuing education certificate and checked

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* 5. Please provide the following information

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* 6. If you are a student, Please provide the name of your school and your area of study.

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* 7. Did you participate in the AHEC/Healthtecdl program from your organization's facilities?

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* 8. If yes, were there other individuals who viewed the presentation with you?

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* 9. If yes, number according to ethnicity and gender who viewed the presentation with you.

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* 10. If yes, please provide the names and email addresses of these people, so we may have a complete record of participants.

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* 11. Please rate the following aspects of the program content:

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* 12. Post Test Question #11. Give two examples of abuse.

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* 13. Post Test Question #2 Give two example of neglect.

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* 14. Post Test Question #3 Give two example of exploitation.

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* 15. Post Test Question #4Give two example of indicators that abuse may occur

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* 16. Post Test Question #5When can a report be made?

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* 17. Post Test Question #6Where to report what types of abuse?

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* 18. Post Test Question #7What type of Abuse should you report?

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* 19. Post Test question 8Give examples of intervention strategies for elder abuse

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* 20. How Would you rate the quality of instruction?

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* 21. How would you rate the quality of the presentation?

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* 22. Based on this activity, do you plan to make changes to your practice/organization?

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* 23. What one thing would you recommend that we change to improve content and/or presentation?

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* 24. Please list suggestions for future topics.

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* 25. Please rate the following aspects of the distance-based network.

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* 26. Please describe any difficulties that you encountered in participating in the program from your location.

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* 27. What one thing would you recommend that we change to the distance based aspect of the program?

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* 28. How did you hear about this program?

* 12. Post Test Question #1

1. Give two examples of abuse.

* 13. Post Test Question #2
Give two example of neglect.

* 14. Post Test Question #3
Give two example of exploitation.

* 15. Post Test Question #4
Give two example of indicators that abuse may occur

* 16. Post Test Question #5
When can a report be made?

* 17. Post Test Question #6
Where to report what types of abuse?

* 18. Post Test Question #7
What type of Abuse should you report?

* 19. Post Test question 8
Give examples of intervention strategies for elder abuse