The Journey Back e-Book Pre-Test Survey

Question Title

* 1. Please answer the following questions to create a User ID: this will be used to match your pre and post test results, the ID will not be kept in the database or linked to your personal record.

What is the name of your first pet?

What city were you born in?

Question Title

* 2. Please check the boxes that best fit you

I was burned

My sister or brother was burned

My mom or dad was burned

My child was burned

I am a burn care professional

I am a school professional

Other (please specify)

Question Title

* 3. Please check the boxes that best fit your age.

13-17 years old

18-25 years old

26-35 years old

36-50 years old

Over 50

Question Title

* 4. Please describe how prepared you feel to carry out each of these tasks using the scale below.
I am prepared to...

	Very Low				Very High
Explain the need for school reentry after a burn injury or traumatic loss	Explain the need for school reentry after a burn injury or traumatic loss Very Low	Explain the need for school reentry after a burn injury or traumatic loss	Explain the need for school reentry after a burn injury or traumatic loss	Explain the need for school reentry after a burn injury or traumatic loss	Explain the need for school reentry after a burn injury or traumatic loss Very High
Explain the benefits of school reentry for burn-injured children	Explain the benefits of school reentry for burn-injured children Very Low	Explain the benefits of school reentry for burn-injured children	Explain the benefits of school reentry for burn-injured children	Explain the benefits of school reentry for burn-injured children	Explain the benefits of school reentry for burn-injured children Very High
Describe the basic elements of a school reentry	Describe the basic elements of a school reentry Very Low	Describe the basic elements of a school reentry	Describe the basic elements of a school reentry	Describe the basic elements of a school reentry	Describe the basic elements of a school reentry Very High
Organize a school reentry	Organize a school reentry Very Low	Organize a school reentry	Organize a school reentry	Organize a school reentry	Organize a school reentry Very High
Discuss school reentry with the family	Discuss school reentry with the family Very Low	Discuss school reentry with the family	Discuss school reentry with the family	Discuss school reentry with the family	Discuss school reentry with the family Very High
Advocate for a child with school or hospital staff regarding school reentry	Advocate for a child with school or hospital staff regarding school reentry Very Low	Advocate for a child with school or hospital staff regarding school reentry	Advocate for a child with school or hospital staff regarding school reentry	Advocate for a child with school or hospital staff regarding school reentry	Advocate for a child with school or hospital staff regarding school reentry Very High
Describe the ways in which a child might express grief or loss	Describe the ways in which a child might express grief or loss Very Low	Describe the ways in which a child might express grief or loss	Describe the ways in which a child might express grief or loss	Describe the ways in which a child might express grief or loss	Describe the ways in which a child might express grief or loss Very High
Coach the returning student in social skills	Coach the returning student in social skills Very Low	Coach the returning student in social skills	Coach the returning student in social skills	Coach the returning student in social skills	Coach the returning student in social skills Very High
Carry out a school reentry for returning student	Carry out a school reentry for returning student Very Low	Carry out a school reentry for returning student	Carry out a school reentry for returning student	Carry out a school reentry for returning student	Carry out a school reentry for returning student Very High
Communicate with the school about a school reentry program	Communicate with the school about a school reentry program Very Low	Communicate with the school about a school reentry program	Communicate with the school about a school reentry program	Communicate with the school about a school reentry program	Communicate with the school about a school reentry program Very High
Evaluate my school reentry presentations	Evaluate my school reentry presentations Very Low	Evaluate my school reentry presentations	Evaluate my school reentry presentations	Evaluate my school reentry presentations	Evaluate my school reentry presentations Very High
Support the returning student's ongoing adjustment in the school setting	Support the returning student's ongoing adjustment in the school setting Very Low	Support the returning student's ongoing adjustment in the school setting	Support the returning student's ongoing adjustment in the school setting	Support the returning student's ongoing adjustment in the school setting	Support the returning student's ongoing adjustment in the school setting Very High

Question Title

* 5. Please rate your overall confidence at this time in carrying out a school reentry for a burn-inured student or student returning after a traumatic loss.

Very Low

Very High

Very Low

Very High

Question Title

* 6. What do you hope to get out of reviewing The Journey Back e-book?

Question Title

Thank you for your help with this survey, please fill out the post-test at the end of the manual after you have reviewed the contents. Click the link below to return to the e-book access page.

www.phoenix-society.org

Question Title

* 1. Please answer the following questions to create a User ID: this will be used to match your pre and post test results, the ID will not be kept in the database or linked to your personal record.

Question Title

* 2. Please check the boxes that best fit you

Question Title

* 3. Please check the boxes that best fit your age.

Question Title

* 4. Please describe how prepared you feel to carry out each of these tasks using the scale below.I am prepared to...

Question Title

* 5. Please rate your overall confidence at this time in carrying out a school reentry for a burn-inured student or student returning after a traumatic loss.

Question Title

* 6. What do you hope to get out of reviewing The Journey Back e-book?

Question Title

Thank you for your help with this survey, please fill out the post-test at the end of the manual after you have reviewed the contents. Click the link below to return to the e-book access page.www.phoenix-society.org

* 4. Please describe how prepared you feel to carry out each of these tasks using the scale below.
I am prepared to...

Thank you for your help with this survey, please fill out the post-test at the end of the manual after you have reviewed the contents. Click the link below to return to the e-book access page.

www.phoenix-society.org