EVALUATION FORM

In order to improve the quality of our next program, we would appreciate receiving your feedback. 

Please feel free to make comments.  We thank you for your cooperation.

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* 1. On a scale of 1 (poor) to 5 (excellent), how well were you able to achieve the session objectives?

  1 2 3 4 5 N/A
A. Communicate the results of the study “Elective Hospitalization Among Childbearing Women with AABC Member Practices 2007-2017”
B. Describe the effects of elective hospitalization of childbearing women.
C. Describe the AABC Maternity Survey and how it might be implemented in your practice.
D. Discuss findings from analysis of client experience data collected from AABC Strong Start sites.
E. Identify concrete ways to incorporate assessment and research in your birth center practice to enhance client outcomes.
F. Develop an evaluation protocol to screen for a breadth of perinatal mental health concerns for new families.

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* 2. On a scale of 1 (poor) to 5 (excellent), please rate the TEACHING EFFECTIVENESS of the presenter.

  1 2 3 4 5 N/A
A. Diana Jolles, PhD, CNM, FACNM
B. Susan Stapleton, DNP, CNM, FACNM
C. Janelle S. Peifer. PhD, Lic. Clinical Psychologist

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* 3. On a scale of 1 (poor) to 5 (excellent), please rate the effectiveness of the TEACHING METHODS used.

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* 4. On a scale of 1 (poor) to 5 (excellent), please rate how well was the PROGRAM MATERIAL ORGANIZED.

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* 5. On a scale of 1 (poor) to 5 (excellent), please rate the session OVERALL.

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* 6. What part of the program provided the most helpful information?

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* 7. What additional information would have been helpful?

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* 8. Additional comments

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* 9. Name (submit if applying for continuing education)

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* 10. Email (optional)

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