Developmental and Social-Emotional Screening Module

Program Evaluation

Thank you for completing the training module. Please take a moment to provide us with feedback. Your feedback helps us improve this module to best meet your needs and the needs of others. This evaluation should take less than 3 minutes to complete.

I. Online Training Module Content

The following questions evaluate the content of the developmental and social-emotional screening module.

For questions 1 - 4, please select the best answer on the following scale: 1=Strongly Disagree, 2=Disagree, 3=Agree, 4=Strongly Agree.

    Strongly
Disagree		 Disagree Agree Strongly
Agree
1) This module was relevant to my practice or clinic.
1
2
3
4
2) This module increased my interest in developmental and/or social-emotional screening of the children I see in my profession.
1
2
3
4
3) I learned something new about developmental and/or social-emotional screening from completing this module.
1
2
3
4
4) Based on what I have learned in this module, I plan to make one or more changes in my practice.
1
2
3
4

5) What was the most important thing you learned?

II. Online Training Module Format

The following questions will address the format of the developmental and social-emotional screening module.

For questions 6 - 7, please select the best answer on the following scale: 1=Poor, 3=Average, 5=Excellent.

    Poor   Average   Excellent
6) Overall quality of the format of the Web-based module.
1
2
3
4
5
7) Overall ease of navigation through the module.
1
2
3
4
5

III. Feedback on Content and Format

8) How could this online training program be improved?

Does not need improvement
Easier navigation through program
Content more clearly written
Better quiz questions to test what I learned
Add more research and evidence-based findings
Comments

9) How long did it take to complete this module?

Less than 15 minutes
15-30 minutes
30-45 minutes
Greater than 45 minutes

IV. General Information

10) What is your practice site?

Public health
Community clinic
Private clinic
School
Day care
Other:

11) Do you perform Child and Teen Checkups?

Yes
No

12) What is your profession?

MD
Advanced Practice Nurse  (e.g. CNP)
RN and/or PHN
Health Educator
Medical Assistant or Certified Nurse’s Aid
Other health care worker
Other:

13) Are you currently using a developmental screening instrument?

Yes
No

If yes, list the instrument:

14) Are you currently using a social-emotional screening instrument?

Yes
No

If yes, list the instrument:

To prevent abuse of this form, please type the following letters/numbers JQFPX into the field below. Thank you.

required

Your time and feedback are appreciated. Thank you!