DATA COLLECTION MANUAL For Entry and Exit Surveys CA PREP Program 2014–2015 (Revised August, 2014)

Prepared by: ETR Associates Research Department and Phillip R. Lee Institute for Health Policy Studies, University of California, San Francisco (UCSF)

Table of Contents Introduction .............................................................................................................................................. 1 Section 1: Overview of Data Collection Manual, Training, and Technical Assistance .............................. 1 Section 2: Overview of Surveys and Requirements ................................................................................. 2 Section 3: Preparing for Survey Administration ....................................................................................... 4 Section 4: Ordering Surveys and Materials .............................................................................................. 7 Section 5: Administering Surveys ............................................................................................................. 9 Section 6: Mailing Completed Surveys ....................................................................................................11 Attachments A: Entry/Exit Survey Preview Protocol B: Passive Consent Template (English/Spanish) C: Active Consent Template (English/Spanish) D: Cover Sheet (Participant Verbal Assent) for Juvenile Justice Facilities E: Participant’s Bill of Rights F: Survey Summary Forms (Entry and Exit) G: Entry Survey Administration Protocol H: Exit Survey Administration Protocol I: Survey Administration Considerations and Tips

Introduction The entry and exit surveys are one component of the PREP Performance Measures; they are a Federal reporting requirement and focus on youth participants’ perceptions of program effectiveness and experiences in the program. This data collection manual is divided into six sections to provide information and answer questions about the entry and exit survey data collection process. The six sections include:  Section 1: Overview of Data Collection Manual, Training and Technical Assistance  Section 2: Overview of Surveys and Requirements  Section 3: Preparing for Survey Administration  Section 4: Ordering Surveys and Materials  Section 5: Administering Surveys  Section 6: Mailing Completed Surveys Section 1: Overview of Data collection Manual, Training and Technical Assistance Why is it important to follow the data collection manual? The data collection manual provides information and step-by-step procedures that must be followed when administering the CA PREP entry and exit surveys to ensure the data meet federal Performance Measure requirements. Following these procedures ensures consistency and success across sub-awardees. Specifically:  Following the procedures ensures that the entry and exit surveys are given the same way in every setting across the State and enhances the quality of the survey data.  Using these procedures shows your community that you respect them by obtaining necessary parent guardian consent and participant assent and that you are protecting the rights and privacy of youth.  Using standard procedures makes the administration go more smoothly. What type of training do I need to administer the surveys? All data collection staff must participate in a data collection training before administering the entry and exit surveys. Each staff member who will be involved in the survey administration or survey preparation should read through this data collection manual. Ongoing data collection webinars will provide training on preparing for and administering the entry and exit surveys. Additional support will be provided through Evaluation Liaisons, Program Consultants and telephone follow-up as needed. Who can administer the entry and exit surveys? The facilitator implementing the EBPM can administer the entry survey. It is recommended that someone other than the facilitator who implemented the EBPM administer the exit survey. This could be someone else from the sub-awardee agency (e.g., another health educator, the program coordinator, or an assistant). If that is not an option, the facilitator who implemented the EBPM can administer the exit surveys.

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How can I get assistance with the survey process? Technical assistance (TA) and support is available to you from your Evaluation Liaison and your MCAH Program Consultant. Your Evaluation Liaison will be in communication with you on an ongoing basis to help you meet the CA PREP survey requirements. If you have any questions about the procedures for preparing parent/guardian consent forms, administering the entry and exit surveys, ordering survey materials, completing the survey summary form or mailing the completed surveys, contact your assigned Evaluation Liaison immediately. Refer to the PREP TA Support Team Master Contact List to identify your agency’s Evaluation Liaison. How can I access the MCAH PREP SharePoint site for survey materials? Electronic versions of all of the data collection materials referenced in this document are available on the MCAH PREP SharePoint Site. 

Access the PREP SharePoint at:  https://portal.dhs.ca.gov/sites/MCAHExtranet/PREP/default.aspx

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Enter your Extranet Username and Password to gain access to the PREP site.

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The MCAH PREP SharePoint site will open to a home page. One this page you will find: o links to all PREP agencies, o a place for PREP program announcements and calendars, and o links to PREP Instructions and Forms (click on this link).

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If you need immediate assistance accessing the survey materials, contact your Evaluation Liaison or Program Consultant.

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If you need assistance accessing the PREP SharePoint site contact your Program Consultant.

Section 2: Overview Entry and Exit Surveys and Survey Requirements Who completes the entry and exit surveys? The PREP entry and exit surveys will be administered to all eligible participating youth at both program entry and exit. The Federal PREP guidelines require that all participants present on the first day of the PREP program (or upon joining the program after the first day) complete an entry survey and that all participants present on the last day of the PREP program complete an exit survey. Effective July 1, 2014, CA PREP will no longer require entry surveys for middle school youth in school-based settings. Use the following guidelines and refer to the diagram below:  Middle school youth (grades 4 – 8) in school-based settings will not complete entry surveys; but will complete exit surveys. o A school-based setting is defined as a program operating in a school, either during school hours or after school. o Entry surveys are required for all other youth, including those in high school settings and those under age 14 who attend programs in non-school settings such as clinics or community centers. o Middle school youth who are in a mixed-grade class (such as grade 8 combined with grade 9) will complete entry and exit surveys.

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Exit surveys, demographic half-sheets, and attendance data are required for all youth, including those served in middle schools.

Entry Surveys

Exit Surveys

All CA PREP Participants EXCEPT: •Middle School grades 4-8 in school-based setting (during or after school)

All CA PREP Participants

Do participants have to put their name on the survey? Participants will not put their names on the surveys; these are anonymous surveys (no names will be collected). MCAH is adding three demographic-like items to the end of the entry and exit survey to facilitate linking participants’ entry and exit surveys anonymously. All data will be reported in the aggregate (group level); no individual data will be reported. What do the entry and exit surveys ask about? The entry survey consists of 30 questions and the exit survey consists of 18 questions. In general, the entry and exit survey items ask about the demographic characteristics, sexual risk behaviors, and perceptions and program experiences of the participants served by CA PREP. Additional survey items cover topics such as healthy relationships, dating violence, and clinical linkages. The entry and exit surveys and data collection procedures have been reviewed and approved by the State of California’s Internal Review Board (IRB), Committee for the Protection of Human Subjects. Can we change the wording of the questions to better meet the needs of our populations? No. The questions on the entry and exit surveys were established by the Federal PREP program. The Spanish translation was also provided by the Federal PREP program. The wording cannot be changed nor can any items be eliminated from the surveys. When are the surveys administered? The surveys are administered at the start of the program, during the program and at the end of the program. Refer to the diagram below.

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Start of progarm •Administer entry surveys before program begins •Up to 7 days in advance or on first day of program

During program •Administer entry survey to new participants (newcomers)

End of program •Administer exit surveys •Last day of program or up to 7 days later

How long do the surveys take to administer? In most instances, you should plan on approximately 15 minutes to administer the entry survey and 15 minutes to administer the exit survey each time. This includes the time necessary to go over the instructions, pass out, and collect surveys. Be sure to verify the amount of time you have available before you begin. Determine when you will administer the entry surveys (i.e., up to one week before implementation or the first day) and the exit surveys (i.e., on the last day of implementation or up to one week after implementation). There are several important timing considerations to keep in mind as you are planning how much time you need to administer the entry and exit surveys. Factors that will influence your timing include: 

Setting and number of participants you are serving.

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Verifying participant eligibility based on consent process. You will need to build in time for the consent process verification. Refer to Verifying Participant Eligibility (under 18 years of age) below.

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Making sure you have sorted through consent forms before the day of entry survey administration and have prepared a list of which participants are not eligible to take the entry and exit surveys. Ideally this should be done before the day of the survey.

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Collecting other data: Youth Demographic Information and Daily Attendance Logs. Make sure you factor in enough time for all the data collection efforts.

How long do the surveys take participants to complete? The entry and exit surveys will take approximately 10 minutes each for the participants to complete; however, there are several steps to follow before and after data collection that will add to the time such as verifying participant eligibility, obtaining participant verbal assent and distributing and collecting survey materials (these are addressed above and in Section 5 on administering the surveys).

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Section 3: Preparing for Survey Administration

What are the approvals needed to administer the entry and exit surveys? The type of setting that your EBPM is being implemented in may determine the type of approvals needed or required to administer the surveys. 

Each sub-awardee is responsible for obtaining the necessary approvals from the school/community to administer the surveys at your service delivery site. Rules may vary from school/community settings. This can take time and negotiations so we encourage you to start early!

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You may need to provide a preview copy of the surveys for your school/community to determine if additional approvals are needed prior to administering the entry and exit surveys. Parents/guardians may also ask to review a copy prior to providing consent.

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We have provided you with a survey review protocol that you can use to help with the survey approval process. (Refer to Attachment A). Your Evaluation Liaison can supply you with an electronic version of the entry and exit surveys, which have a watermark, so that the survey cannot be copied.

Do participants under the age of 18 years old need parent/guardian permission take the entry and exit surveys? Yes, participants under the age of 18 need permission to take the entry and exit survey. There are two types of consent procedures: Passive Consent and Active Consent. 

Passive Consent– means that information is provided to parents/guardians about the survey before you administer it. Parents/guardians can choose to opt their child out of the survey by returning a signed form denying permission. Participants can take part in the survey unless they returned a signed parent permission form marked NO (a template is provided in Attachment B).

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Active Consent – means you must have a signature from each participant’s parent/guardian authorizing the youth’s participation. A participant may not take part in the survey unless there is a signed permission form marked YES. Any participant whose parent/guardian did not return a signed permission form or who marked NO may not take part in the survey (a template is provided in Attachment C).

Unless required by a school or district, we recommend that you use a passive consent process for the entry and exit survey. Passive consent is allowed for anonymous, voluntary surveys per the California Education Code (Section 51938). CA PREP sub-awardees are implementing the PREP interventions in a variety of locations/settings. The parental/guardian notification process will vary by location/setting. The type of setting that your EBPM is being implemented in may determine the type (passive or active consent) of parental notification required for participants under age 18, timing of notification, and other administrative requirements. All participants will be asked for verbal assent at the time the surveys are administered; this process is covered in Section 5. When are parent/guardian consent forms distributed and collected? There are local education codes and laws regarding the timing of parent/guardian notification for administering surveys in school-based settings. Timing may vary by other settings as well. CA PREP Data Collection Manual: August, 2014 (rev.)

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For the CA PREP Program, follow the guidelines provided by the school/community setting regarding parent/guardian consent notification.  If there are no guidelines that exist, please make sure to send the parent/guardian consent forms home a minimum of 7 days before the survey administration date. 

If you are surveying in a school setting, you may be able to work with the classroom teachers to assist in distributing and collecting the parent consent forms.

Note: Parent/guardian consent forms (permission forms) for taking part in the entry and exit survey are separate from any participation forms for the EBPM that you may be using. How do we prepare the parent/guardian consent forms? It is the responsibility of each CA PREP sub-awardee to prepare the consent forms for survey approval using the templates provided. These forms are available in English and Spanish. (Refer to Attachments B and C.) Word versions of the consent form templates are available from your Evaluation Liaison and may be accessed on the MCAH PREP SharePoint site. These are ready to use with just a few simple steps to customize the consent form for your use. 1. Select the active or passive version of the parent consent form template in English, Spanish or both based on the requirements of the setting in which you are working and the population you are serving. 2. Save the file on your hard drive. A suggested file naming convention may be:  Agency#_Parent Consent [Active or Passive]_[English or Spanish]_SITENAME_YEAR 3. There are three places on the template where you will insert information based on your agency and implementation cycle; these are highlighted in yellow. DO NOT CHANGE ANY OF THE INFORMATION OR WORDING OTHER THAN WHERE INDICATED TO DO SO.  Front Page: Insert information for your agency where indicated (contact name, school or agency name, phone number).  Back Page: Insert information for your agency where indicated (contact name, school or agency name, phone number).  Back Page: Insert to whom and by when the consent form is to be returned where indicated (name/location) by (Date).  Before printing, remove the highlighted title ‘CONSENT_TEMPLATE,’ and remove all other highlighting in the document.  Print on your agency letterhead. 4. If you need assistance, contact your Evaluation Liaison. 5. Have your Evaluation Liaison review your consent forms before you send them out. How do I confirm participant eligibility to take the surveys? Depending on the type of consent process used (passive or active), you will need to maintain a list of participants whose parents/guardians provided or denied consent to participant in the surveys in order to verify participant eligibility to take the surveys. Here is one way to do this: 

Verifying participant eligibility for passive consent:  Obtain a list of participants under age 18 whose parents/guardians returned a signed form refusing consent.  For each participant whose parent/guardian returned a negative consent form: DO NOT SURVEY.

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Verifying participant eligibility for active consent:  Every participant under the age of 18 must have returned a signed parent/guardian consent form.  For each participant, verify if they have returned a consent form, and if the consent is positive (Yes) or negative (No).  If a participant has not returned a signed consent form: DO NOT SURVEY.  If a participant has returned a signed consent form and if the consent form is negative (No): DO NOT SURVEY.

Do I need to store the parent/guardian consent forms returned? Yes. It is a requirement that the sub-awardees store the parent/guardian consent for three years from the end date of the CA PREP project. For active consent, this includes all signed consent forms marked ‘Yes’ or ‘No.’ For passive consent, this includes only the signed consent forms marked ‘No.’ We recommend that you store them in an envelope with the cohort number, site and date clearly marked on the outside in a secure location. Section 4: Ordering Surveys and Materials What materials will we get ready to use and what do we need to prepare? Most of the survey materials needed for administering the entry and exit survey will be ready to use or provided for you. There are a few materials that you will need to customize to your agency and make copies of to distribute to your participants. Table 1 provides an overview of the materials needed to administer the entry and exit surveys, which will be ready to use and what you need to do to prepare. How often we need to order surveys and materials? Plan to order your surveys and materials on a quarterly basis based on the number of participants you intend to serve. Use your EBPM Planning Calendar to estimate the number of surveys you will need. Your Evaluation Liaison will send a reminder email with the survey order form link one month before each quarter begins. Please allow at least two weeks to process your survey order. How do we order surveys and materials? To order surveys and materials, complete an online Survey Order Form. Order additional materials as needed using the online order form. Your Evaluation Liaison will work closely with you to ensure that you have the necessary survey materials.  To complete the Survey Order Form, go to the link at MCAH PREP SharePoint site.  To complete your order, you will need the following information: (1) estimated number of participants to be served for each cohort per quarter (based on your EBPM planning calendar), (2) estimated number of Spanish surveys, and (3) estimated number of staple-less surveys if you are implementing in juvenile justice facilities.  In the interest of limiting survey printing costs, please be mindful of the number of surveys ordered relative to the number of youth you expect to serve and the number of surveys remaining from your last survey order. To reduce the possibility of survey loss, please only order surveys needed for the quarter.  The following materials will be included in the survey order: 1. Entry and Exit Surveys (sufficient copies for the number of participants to be surveyed per quarter).

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2. Cover sheet for Juvenile Justice Facilities (alternative version to be copied and distributed with the entry/exit surveys to participants being surveyed in juvenile justice facilities only, refer to attachment D). 3. Participants’ Bill of Rights (to be copied and provided to all participants per survey administration script, refer to Attachment E). 4. Survey Summary Forms (to be copied for each cohort; there are separate Entry and Exit Survey Summary Forms, refer to Attachment F). 5. Envelopes labeled “Completed Surveys” (there are separate envelopes for Entry, Newcomer and Exit). 6. Survey return pre-addressed mail labels (return postage is paid by sub-awardee). 7. Facilitator checklist of survey materials for each cohort.

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Table 1: Overview of Materials Needed to Administer Entry and Exit Surveys

What do I need?  Data Collection Manual. One version of the CA PREP Data Collection Manual will be provided in a binder to each PREP sub-awardee.  Entry/Exit Surveys. There is one version of each survey that will be used. The items are different on the entry and exit survey. The surveys are available in English and Spanish.

Where do I get it?  Additional copies may be downloaded from the MCAH PREP SharePoint site.

 Survey summary forms. There is an entry survey summary form and an exit survey summary form. These forms are completed by the data collector for each batch of entry and exit surveys (per cohort). These forms provide important information about the data collection for each cohort.  Parent Consent Form. The master template of the State IRB approved parent consent form. There is a passive and active consent version for you to choose from.  This will need to be customized with your EBPM/agency information. This is available in English and Spanish.  Coversheet for Juvenile Justice Facilities. The master copy that is State IRB approved and is required to be distributed and read aloud to participants being surveyed in juvenile justice centers. This is available in English and Spanish. Note: This is an alternate version (specific to juvenile justice facilities) from the cover sheet on the entry/exit surveys.  Participants’ Bill of Rights. The master copy that is State IRB approved and is required to be distributed to every nonmiddle school participant before administering the entry survey and to every middle school student (grades 4 to 8 in school based settings) before administering the exit survey. This is available in English and Spanish.

 A master copy of the entry and exit survey summary forms will be provided as part of the survey materials sent with each survey order.  A Word version will also be available from your Evaluation Liaison and on the MCAH PREP SharePoint site.  Word versions of the parent consent forms are available from your Evaluation Liaison on the MCAH PREP SharePoint Site.

 Completed Surveys Envelopes. Two envelopes per cohort to collect completed entry and exit surveys after survey administration for each cohort.

 Completed surveys envelopes will be provided as part of the survey materials with each survey order.  An extra completed surveys envelope for newcomers will also be provided.  Pre-printed survey return mail labels will be provided as part of the survey materials with each survey order.

 Pre-printed Survey Return Mailer Labels. Each Sub-awardee will be provided pre-printed survey return mail labels addressed to their assigned Evaluation Liaison for returning completed surveys.

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 Complete a survey order form.  Entry and exit surveys will be mailed to you; they are not available to download.

 A master copy-ready version will be provided as part of the survey materials sent with each survey order.  A Word version will also be available from your Evaluation Liaison and on the MCAH PREP SharePoint site.  A master copy-ready version will be provided as part of the survey materials sent with each survey order.  Laminated copies of the Participants’ Bill of Rights will be provided with your initial survey order.

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How many do I need?  One copy per data collector.

 An entry and exit survey is given to every participant before and after your EBPM implementation.  The entry and exit surveys will be pre-printed and sufficient copies will be provided to each sub-awardee based on the number of participants to be served.  Sub-awardees will use the master copies of the entry and exit survey summary forms to make enough copies based on the number of cohorts they are implementing.  Submit a survey summary form for each batch of completed entry and exit surveys per cohort submitted.  Once this is customized, sub-awardees will make enough copies to distribute to participants at least 7 days prior to administering (or whatever the local requirements are) the entry survey. (Refer to Preparing Parent Consent Forms in Section 3).  Sub-awardees will use this master copy to make enough copies to distribute to participants in juvenile justice facilities only.

 Sub-awardees will use this master copy to make enough copies to distribute to all non-middle school participants served per cohort prior to entry survey and to all middle school participants (grades 4 to 8 in school based settings) prior to exit survey; and at exit for middle school.  The laminated Participants’ Bill of Rights can be re-used at entry survey administration to direct participants to what is being distributed.  Sub-awardees will need a Completed Entry Survey Envelope and a Completed Exit Survey Envelope for each cohort.  One cohort per completed surveys envelope.  The number of survey return mail labels depends on how many envelopes or boxes of completed entry and exit surveys you will be mailing.

Section 5: Administering the Entry and Exit Surveys This section provides an overview of the important steps to follow before, during and after administering the entry and exit surveys. We have prepared separate entry and exit survey administration protocol to be read aloud while administering the surveys (refer to Attachments G and H for the entry and exit survey protocols, respectively). The steps for administering both the entry and exit survey are essentially the same with one exception; at exit you will not distribute the Participants’ Bill of Rights. What are some of the key concerns to pay attention to when administering the surveys? The following information provides important and critical reminders for you while interacting with participants, teachers and other personnel in the setting in which you will be administering the surveys. Refer to Attachment J for more details and tips. 

Participant confidentiality  The surveys contain questions of a sensitive nature. Facilitate everything reasonable to assure confidentiality and to encourage participants to answer honestly.  If possible, arrange the seats or tables so participants can’t see each other’s responses.  Encourage participants to use a blank sheet of paper (cover sheet from survey) to cover their responses as they progress through the survey.  Do not walk around the room except to answer a question.  Do not look at blank or completed surveys in front of the participants or with a host teacher/other adult.  Assure the participants that no one will see their answers.  Voluntary participation and refusals  Please remember that taking the surveys are voluntary. If a participant refuses to complete the survey or does not complete the surveys, he or she should not be pressured to do so. Do not ask for a reason for their refusal.  Answering questions from participants  Be prepared to answer questions from participants about the survey itself, and about topics covered on the survey.  When responding to an individual participant, go to their seat. You can restate or clarify an item or pronounce a word; however, never clarify an item in a way that may imply a preferred or correct answer.  If you need to clarify a term on the survey, you may write a definition on the board (or explain it verbally to the group).  Walk away from participant before they record a response.  If you are unsure how to answer the question, don’t answer it. Tell the participant that you cannot answer their question, and ask them to do the best they can.

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How do I prepare BEFORE the survey? Prepare survey materials for each cohort/site using the following as a checklist to guide you. A copy of this checklist will also be provided in your survey order.

 A copy of the Data Collection Manual. The survey administration protocols must be followed closely to help ensure quality and uniformity of the data.

 Entry and exit surveys (enough for anticipated number of participants to be surveyed per cohort).

Plan to have Entry surveys on hand at each session to survey new participants that arrive after the first session.

 Copies of Cover Sheet (Participant Verbal Assent) for Juvenile Justice Facilities (prepare enough

copies for the anticipated number of participants for each cohort for entry and exit, Attachment D)

 Copies of the Participants’ Bill of Rights (prepare enough copies for the anticipated number of

participants for each non-middle school cohort at entry survey and each middle-school cohort (grades 4 to 8 in school based settings) at exit survey). A laminated copy of Participants’ Bill of Rights to use as an example (Attachment E). If participants do not wish to keep a copy, you may reuse these for the next cohort.

 Copies of survey summary forms; there are separate forms for entry and exit (Attachment F).  Sealable envelopes for completed surveys labeled Completed Entry Surveys/Completed Exit Surveys.

These envelopes will be provided to you with your survey order. Use one envelope per cohort for completed entry surveys (Pink label) and one envelope per cohort for completed exit surveys (Green Label). Place the completed entry surveys for newcomers in the Completed Entry Surveys (newcomers) envelope (Yellow Label).

 A list of participants who are NOT able to take the survey based on the parent consent process.  Planned alternative activities for participants not taking the surveys (e.g., read a book, work on a quiet activity at seat, etc.)

 Prepare sufficient copies of the Youth Demographic Information Sheets (half sheets and instructions provided on page 2 of the Attendance Log_Fidelity Checklist instructions on MCAH SharePoint site; click Forms and Instructions).

What do I do the DAY of the survey? 1. Assess the room for seating arrangements of the room for privacy. If possible, work with the classroom teacher to arrange the desks or tables so that chairs and desks are spaced appropriately so that no participant can see other participants’ answers. 2. Administer the entry or exit survey using the step-by-step survey administration protocol provided in Attachment G and H.  Important Reminder: The survey cover sheet is part of the participant verbal assent process. Participant verbal assent is used to inform participants about their rights to refuse to take part in survey even if their parent/guardian consented. The cover sheets are for participants to keep, but many will not want them and you may end up just recycling them.  The act of tearing off the cover sheet signals that the participants have provided assent to the survey process after the instructions have been read aloud.

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Please review this process for administering the entry/exit survey administration protocols, Attachments H & I (step 4) of the data collection manual with all of the data collectors to ensure that the guidelines are being followed. Data collectors read the survey cover sheet aloud. If you are administering in a juvenile justice facility, then you make copies of the alternative version of the survey cover sheet for Juvenile Justice Facilities (master copy provided with survey materials) and distribute those with the surveys for the participants to follow along as you read. The specific instructions provided in the protocol are shaded in grey:  If you agree to take the survey, please tear off the cover sheet. The copy is yours to keep. If you do not agree to take the survey, please turn over the survey booklet on your desk and take out an alternative activity while the others are taking the survey. I will collect the blank surveys.

3. Collect the completed surveys.  As you collect the completed surveys, place them into the appropriately marked envelope (i.e., Completed Entry Surveys: bright pink label; Completed Entry Surveys (newcomers; yellow label) or Completed Exit Surveys: bright green label) so that the participants see you doing this.

___ Cohort Number

Completed ENTRY

Surveys

___ Cohort Number Completed NEWCOMER

___ Cohort Number Completed EXIT

Surveys

Surveys

Count the number of surveys you picked up. Verify this count with the number of participants present and taking the survey. Make sure to account for all surveys.  Under no circumstances should a partially completed survey be left with the teacher/other personnel for the participant to finish at a later time. Collect all surveys, completed or not, and place them in the envelope once you have finished the survey administration. Thank the participants for completing the survey. Complete the survey summary form. Prepare surveys to be mailed to your Evaluation Liaison (refer to Section 6). Assess your survey materials for your next survey administration to be sure you have enough; reorder materials if needed. 

4. 5. 6. 7.

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How do I administer the survey to participants who arrive after the first day (newcomers)? If a new participant arrives after the first session (newcomer), the facilitator will need to administer the entry survey before the participant joins the session. Depending on your setting, you may or may not have new participants join after the first session. We recognize that administering the entry survey to participants who join the program after the first session presents some challenges, especially if there is only one facilitator. Please follow these guidelines to the best of your ability while in the field and use the Survey Summary Form to document any circumstances that impacted survey administration. 

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Before administering the Entry/Exit Survey, confirm participant eligibility to take part. This means that the parent consent process has been followed and that you have confirmation of participants whose parents/guardians have provided or denied consent.  If a parent consent form was not sent home for this participant and /or there is not sufficient time to properly consent for the survey DO NOT ADMINISTER ENTRY SURVEY.  Note on the Entry Survey Summary Form the details and number of participants impacted. If you have confirmed that the parent consent process has been followed for a Newcomer, then you can proceed to administer the Entry survey (be sure to follow protocol for obtaining verbal assent and provide a copy of Participants’ Bill of Rights).  Find a quiet place in the class/setting to administer the entry survey.  If you have two facilitators, one can start the lesson for the day and the second can administer the entry survey for the newcomer(s).  Participants can join the session after they complete the survey.

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If you are unable to follow the survey administration protocol for obtaining verbal assent and providing the Participant’s Bill of Rights DO NOT ADMINSTER THE ENTRY SURVEY and note the details on the Entry Survey Summary Form. For entry surveys from participants who arrive after the first day, complete a separate Entry survey summary form and place the completed entry surveys in an envelope labeled Completed Entry Surveys for Newcomers. Keep this envelop in a secure location. If more newcomers arrive during the course of the EBPM, keep all completed entry surveys for newcomers in one envelope. There is a space on the Entry Survey Summary Form to indicate the survey dates for newcomers.

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Section 6: Mailing Completed Surveys What do I do with the completed surveys? Keep completed surveys in your possession at all times when you are in the field or locked in a secure location until you are ready to mail them to your Evaluation Liaison. Once you are back at your office, prepare the completed entry and exit surveys to be shipped back to your Evaluation Liaison. Before you seal the envelopes and mail the completed surveys, there are a few things to verify: 1. Complete all of the information on the survey summary form:  COUNT the number of completed surveys to verify that they match with information on the survey summary form.  REVIEW the survey summary form and make sure that all of the information is completed.  PLACE the completed surveys and the summary form in the envelope.  SEAL the envelope. 2. If your cohort start and end dates are within 7 days, mail completed entry and exit surveys at one time and within 3 business days of completing each cohort.  You can mail completed entry and exit surveys for multiple cohorts at one time.  Be sure that there is one cohort in each completed surveys envelope; and  Do not mix completed entry and exit surveys in one completed surveys envelope; you can combine these into a larger envelope or box to mail back to your Evaluation Liaison. 3. If your cohort start and end dates are MORE than 7 days apart:  Mail completed entry surveys within 3 business days of collecting the data;  Mail completed exit surveys within 3 business days of completing the cohort. 4. Mail completed entry surveys for participants who arrive after the first day with the completed exit surveys for that cohort. 5. You can use the pre-printed return address labels provided.  It is strongly recommended that completed surveys are sent via a trackable or traceable mail (e.g., UPS, FEDx, United States Post Office).  You can use the Tracking Form (Green Form) through the United States Postal Service for approximately .90¢ per package. This will allow you to track the delivery of the surveys.  They do not need to be sent overnight; ground delivery is fine. Pre-Printed Return Mail Labels Evaluation Liaison: (please check one)  Kris Freiwald  Seow Ling Ong  Lisa Unti

Evaluation Liaison: (please check one)  Anya Gutman  Leah Maddock

CA PREP Surveys ETR Associates 4 Carbonero Way Scotts Valley, CA 95066

CA PREP Surveys University of California Phillip R. Lee Institute for Health Policy Studies 3333 California Street, Ste. 265 San Francisco, CA 94143

CA PREP Data Collection Manual: August, 2014 (rev.)

14

Attachment: A: Entry/Exit Survey Preview Protocol

To: From: Date: RE:

CA PREP Sub-Awardee Project Coordinators Evaluation Team (ETR_MCAH_UCSF) Fall, 2014 Preview Copy of CA PREP ENTRY/EXIT Survey

Attached is a preview copy of the 2014-2015 CA PREP Entry/Exit surveys for your reference. This survey has been revised from last year. While condom knowledge and skills remain a CA PREP priority, during the next program year, the CA survey items will focus on understanding PREP youth’s experience and knowledge around healthy relationships. Healthy relationships is a Family and Youth Services Bureau(FYSB) designated adult preparation subject (APS) and a priority topic for MCAH and CA PREP. Please use this copy for school/community preview to determine if additional approvals are needed prior to administering the Entry/Exit Surveys. We ask that you follow these procedures and bear in mind the following: 1. We are not able to change any of the wording of the instructions, items or response options. We are federally required to collect these items as part of the CA PREP Performance Measures. 2. Identify one contact person who will keep the preview copy of the surveys in a secure location (typically the project coordinator). 3. Please do not allow those reviewing the survey to take it home or to make a copy of it. 4. Please do not copy or duplicate the survey and share it among staff, or allow anyone else to do so either. 5. Here are some specific details about the CA PREP ENTRY/EXIT surveys: a. Every program participant will be asked to complete the Entry and Exit surveys. b. The survey questions are being used in current Federal Initiatives. c. All measures have been pilot-tested in English at the federal level. d. The survey will take approximately 10 minutes to complete and students may ask questions to the data collection staff, if needed. e. Participation is completely voluntary and participants may refuse to participate or stop participating at any time for any reason. f. Parents/guardians will receive information about the survey and may choose to not allow their child to participate. If you have questions please contact the following: For questions related to the survey, contact: Dr. Mara Decker, DrPH

Project Director, TPP evaluation

University California, San Francisco [email protected] 415-476-3375

For general questions related to CA PREP, contact: Yvette Albright, MSW Chief, Teen Pregnancy Prevention Section California Department of Public Health [email protected] 916-650-0372

Attachment B: Passive Consent Templates (Note: You must customize this for your agency using the Microsoft Word versions)

PASSIVE CONSENT_TEMPLATE

PERSONAL RESPONSIBILITY AND EDUCATION PROGRAM EVALUATION Principal Investigator: Claire Brindis, DrPH University of California, San Francisco What is the Personal Responsibility and Education Program Evaluation? This is an evaluation conducted by Dr. Claire Brindis, DrPH of the University of California, San Francisco. It is funded by the Family and Youth Services Bureau under the direction of the State of California’s Maternal, Child and Adolescent Health Program. It is a survey to see how well sex education/health programs educate youth about teen pregnancy. Some questions ask about your child’s own sexual behavior. Participation is voluntary. Your child is being asked to take part in the survey because s/he is taking part in a sex education/health program this year. The purpose of this evaluation is to learn more about what youth think and what they learn from their sex education/health programs. About 16,000 youth in California will take part in this evaluation. Does my child have to take part? No. Taking part in this evaluation is voluntary. Even if you give permission, your child may skip questions or decide not to fill out the survey at all. If your child decides not to take part in the survey, it will not affect his/her participation in any program or activity or his/her grades at school. If you decide your child should not take part, or if your child chooses not to take part, the person giving the survey or your child’s teacher will give your child another activity to do during the survey. What will happen if my child takes part in this evaluation? Your child will fill out a survey two times– once at the beginning of the program and once when the program is complete. The survey should take about 10 minutes to fill out each time. How are my child’s answers kept private? This survey is anonymous; your child’s name will not go on the survey. There is no other way that the answers will be linked to your child. If information from this evaluation is published or presented at scientific meetings, no names or personal information will be used. What risks can my child expect from being in the evaluation? This project presents little risk to the youth taking part. No names will be used in any reports about this evaluation. Your child might feel uncomfortable reading or answering questions about sexual activity. Your child does not have to answer any questions if s/he does not want to. If your child decides not to take the survey, it will not affect whether s/he can take part in any program or activity, and will not affect his/her grades. Are there benefits to taking part in the evaluation? There will be no direct benefit to your child for taking part. However, the survey results may help health professionals improve educational programs aimed at reducing teen pregnancy. Is there a cost to be in this evaluation? Will my child be paid for participation? There is no charge for being in this evaluation. Your child will not be paid for taking part in this evaluation. What if I have comments or concerns about my child taking part in this evaluation? If you have any comments or concerns about your child taking part in this evaluation, you should first talk with the health educators that are distributing the survey: (contact name, school or agency name, phone number). You may also call Dr. Claire Brindis, Principal Investigator, at (415) 476-3375 at the University of California, San Francisco. You may call collect. Taking part in this evaluation is your and your child’s choice. You and your child may choose either to take part or not to take part. No matter what decision you make, there will be no penalty to you or your child in any way. See the Research Participant’s Bill of Rights for more information.

6-2014

PERSONAL RESPONSIBILITY AND EDUCATION PROGRAM EVALUATION Principal Investigator: Claire Brindis, DrPH University of California, San Francisco

Parent/Guardian Withdrawal Form We are asking for your permission to allow your child to take part in an evaluation of a sex education/health program. The evaluation is conducted by Dr. Claire Brindis, DrPH of the University of California, San Francisco and is sponsored by the California Department of Public Health. The evaluation consists of a survey about your child’s health. The questions on the survey cover topics such as sexual activity, healthy relationships, dating violence, knowledge of reproductive health and services, and opinions about the program. Some questions ask about your child’s own sexual behavior. Project staff will give the survey. The survey results will help us find out if the program is successful in educating youth about teen pregnancy. If you do not want your child to complete the survey, s/he will still be allowed to take part in the program. THERE ARE NO NAMES ON THE SURVEY. Your child will not be asked to put his/her name on the survey.

PARTICIPATION IS VOLUNTARY. Your child has the right not to be in this evaluation or to stop being in the evaluation at any time. Choosing not to fill out the survey will not affect his/her ability to take part in any program or activity, or his/her grades in school. If you have any questions, or would like to see a blank copy of the survey, please call (contact name) from (school or agency name) at (phone number). If you do not want your child to complete the survey you must return this form to (name/location) by (date)

RETURN THIS FORM IF YOU DO NOT WANT YOUR CHILD TO PARTICIPATE My child, (Please print your child’s name)

 MAY NOT participate in the evaluation (survey)

Parent/Guardian (please print)

THANK YOU FOR YOUR CONSIDERATION 6-2014

Signature of Parent/Guardian

Date

PASSIVE CONSENT TEMPLATE EVALUACIÓN DE RESPONSABILIDAD PERSONAL Y DEL PROGRAMA DE EDUCACIÓN Investigador principal: Claire Brindis, DrPH Universidad de California, San Francisco ¿Qué es la Evaluación de Responsabilidad Personal y del Programa de Educación? Esta es una evaluación dirigida por la Dra. Claire Brindis de la Universidad de California, San Francisco. Esta evaluación es financiada por la Oficina de Servicios Familiares y de Jóvenes bajo la dirección del Programa de Salud Materna, Infantil y de Adolescentes del Estado de California. Esta es una encuesta para evaluar cuán bien los programas de educación/salud sexual educan a los adolescentes jóvenes sobre el embarazo. Unas preguntas son sobre el propio comportamiento sexual de su hijo. La participación es voluntaria. Se le pide a su hijo que participe en la encuesta porque este año participa en un programa de educación/salud sexual. El objetivo de esta evaluación es saber más sobre lo que piensan los jóvenes y lo que aprendieron en sus programas de educación/salud sexual. Aproximadamente 16,000 jóvenes en California participarán en esta evaluación. ¿Mi hijo tiene que participar? No. La participación en la evaluación es voluntaria. Incluso si usted da su permiso, su hijo puede saltar preguntas o decidir no completar la encuesta. Si su hijo decide no participar en la encuesta, esto no afectará su participación en ningún programa o actividad ni sus notas en la escuela. Si decide que su hijo no debería participar, o si su hijo elige no hacerlo, la persona que entrega la encuesta o el maestro de su hijo le dará a su hijo otra actividad para realizar durante la encuesta. ¿Qué sucederá si mi hijo participa en la evaluación? Su hijo completará una encuesta dos veces, una vez al comienzo del programa y otra vez una vez que se finalice el programa. Completar la encuesta tomará unos 10 minutos. ¿Cómo se mantiene la privacidad de las respuestas de mi hijo? Esta encuesta es anónima; el nombre de su hijo no aparecerá en la encuesta. No hay ninguna otra forma en que se puedan relacionar las respuestas con su hijo. Si la información de esta evaluación se publica o presenta en reuniones científicas, no se usarán nombres ni información personal. ¿Qué riesgos puede esperar mi hijo por participar en la evaluación? La participación en este proyecto presenta un riesgo mínimo. No se usarán nombres en ningún informe sobre esta evaluación. Su hijo puede sentirse incómodo leyendo o respondiendo a las preguntas sobre actividad sexual. Su hijo no tiene que responder preguntas si no lo desea. Si su hijo decide que no participara en la encuesta, no afectará su posibilidad de participar en el programa o actividad, y no afectará sus notas. ¿Hay algún beneficio por participar en la evaluación? No habrá ningún beneficio directo por la participación de su hijo. Sin embargo, los resultados de la encuesta pueden ayudar a los profesionales de la salud a mejorar los programas educativos destinados a reducir el embarazo entre los adolescentes. ¿Tiene algún costo participar en esta evaluación? ¿Le pagarán a mi hijo por participar? No hay cargo alguno por participar en esta evaluación. Su hijo no recibirá ningún pago por participar en esta evaluación. ¿Qué sucede si tengo comentarios o dudas sobre la participación de mi hijo en la evaluación? Si tiene comentarios o dudas sobre la participación de su hijo en esta evaluación, deberá hablar primero con los educadores de salud que distribuyen la encuesta: (nombre de contacto, nombre de la escuela o agencia, número de teléfono). Puede llamar también a la Dra. Claire Brindis, Investigadora Principal, al (415) 476-3375 en la Universidad de California, San Francisco. Puede llamar con cobro revertido. Participar en esta evaluación es su elección y la de su hijo. Usted y su hijo pueden elegir participar o no. No importa la decisión que tome, no habrá ningún tipo de penalidad para usted o su hijo. Vea la Carta de Derechos de los Participantes de una Investigación para más información.

6-2014

EVALUACIÓN DE RESPONSABILIDAD PERSONAL Y DEL PROGRAMA DE EDUCACIÓN Investigador principal: Claire Brindis, DrPH Universidad de California, San Francisco

Formulario de Retiro de Padres/Tutor Estamos pidiendo su permiso para permitir que su hijo participe en una evaluación del programa de educación/salud sexual. La evaluación la realizará la Dra. Claire Brindis de la Universidad de California, San Francisco y está auspiciada por el Departamento de Salud Pública de California. La evaluación consiste en una encuesta sobre la salud de su hijo. Las preguntas de la encuesta cubren temas como actividad sexual, relaciones sanas, violencia entre parejas, conocimiento de salud y servicios reproductivos, y opiniones sobre el programa. Unas preguntas son sobre el propio comportamiento sexual de su hijo. El personal del proyecto entregará la encuesta. Los resultados de la encuesta nos ayudarán a determinar si el programa tiene éxito en la educación de los jóvenes sobre el embarazo entre los adolescentes. Si no desea que su hijo complete la encuesta, igual tendrá derecho a participar en el programa. NO HAY NOMBRES EN LA ENCUESTA. No se pedirá que su hijo ponga su nombre en la encuesta. LA PARTICIPACIÓN ES VOLUNTARIA. Su hijo tiene el derecho a no participar en esta evaluación o a dejar de participar en cualquier momento. Si elige no completar la encuesta, la capacidad de su hijo de participar en el programa o actividad, ni las notas en la escuela se verán afectadas. Si tiene preguntas, o desea ver una copia en blanco de la encuesta, por favor llame a (nombre de contacto) de (nombre de la escuela o agencia) al (número de teléfono). Si no desea que su hijo complete la encuesta debe devolver este formulario a (nombre/ubicación) antes de (fecha)

DEVUELVA ESTE FORMULARIO SI NO DESEA QUE SU HIJO PARTICIPE Mi hijo, (Por favor escriba el nombre del niño en imprenta)

 NO PUEDE participar en la evaluación (encuesta)

Padre/Tutor (en imprenta)

¡GRACIAS POR SU CONSIDERACIÓN! 6-2014

Firma del Padre/Tutor

Fecha

Attachment C: Active Consent Templates (Note: You must customize this for your agency using the Microsoft Word versions)

6-2014

ACTIVE CONSENT_TEMPLATE

PERSONAL RESPONSIBILITY AND EDUCATION PROGRAM EVALUATION Principal Investigator: Claire Brindis, DrPH University of California, San Francisco What is the Personal Responsibility and Education Program Evaluation? This is an evaluation conducted by Dr. Claire Brindis, DrPH of the University of California, San Francisco. It is funded by the Family and Youth Services Bureau under the direction of the State of California’s Maternal, Child and Adolescent Health Program. It is a survey to see how well sex education/health programs educate youth about teen pregnancy. Some questions ask about your child’s own sexual behavior. Participation is voluntary. Your child is being asked to take part in the survey because s/he is taking part in a sex education/health program this year. The purpose of this evaluation is to learn more about what youth think and what they learn from their sex education/health programs. About 16,000 youth in California will take part in this evaluation. Does my child have to take part? No. Taking part in this evaluation is voluntary. Even if you give permission, your child may skip questions or decide not to fill out the survey at all. If your child decides not to take part in the survey, it will not affect his/her participation in any program or activity or his/her grades at school. If you decide your child should not take part, or if your child chooses not to take part, the person giving the survey or your child’s teacher will give your child another activity to do during the survey. What will happen if my child takes part in this evaluation? Your child will fill out a survey two times– once at the beginning of the program and once when the program is complete. The survey should take about 10 minutes to fill out each time. How are my child’s answers kept private? This survey is anonymous; your child’s name will not go on the survey. There is no other way that the answers will be linked to your child. If information from this evaluation is published or presented at scientific meetings, no names or personal information will be used. What risks can my child expect from being in the evaluation? This project presents little risk to the youth taking part. No names will be used in any reports about this evaluation. Your child might feel uncomfortable reading or answering questions about sexual activity. Your child does not have to answer any questions if s/he does not want to. If your child decides not to take the survey, it will not affect whether s/he can take part in any program or activity, and will not affect his/her grades. Are there benefits to taking part in the evaluation? There will be no direct benefit to your child for taking part. However, the survey results may help health professionals improve educational programs aimed at reducing teen pregnancy. Is there a cost to be in this evaluation? Will my child be paid for participation? There is no charge for being in this evaluation. Your child will not be paid for taking part in this evaluation. What if I have comments or concerns about my child taking part in this evaluation? If you have any comments or concerns about your child taking part in this evaluation, you should first talk with the health educators that are distributing the survey: (contact name, school or agency name, phone number). You may also call Dr. Claire Brindis, Principal Investigator, at (415) 476-3375 at the University of California, San Francisco. You may call collect. Taking part in this evaluation is your and your child’s choice. You and your child may choose either to take part or not to take part. No matter what decision you make, there will be no penalty to you or your child in any way. See the Research Participant’s Bill of Rights for more information. 6-2014

PERSONAL RESPONSIBILITY AND EDUCATION PROGRAM EVALUATION Principal Investigator: Claire Brindis, DrPH University of California, San Francisco

Parent/Guardian Consent Form We are asking for your permission to allow your child to take part in an evaluation of a sex education/health program. The evaluation is conducted by Dr. Claire Brindis, DrPH of the University of California, San Francisco and is sponsored by the California Department of Public Health. The evaluation consists of a survey about your child’s health. The questions on the survey cover topics such as sexual activity, healthy relationships, dating violence, knowledge of reproductive health and services, and opinions about the program. Some questions ask about your child’s own sexual behavior. Project staff will give the survey. The survey results will help us find out if the program is successful in educating youth about teen pregnancy. If you do not want your child to complete the survey, s/he will still be allowed to take part in the program. THERE ARE NO NAMES ON THE SURVEY. Your child will not be asked to put his/her name on the survey.

PARTICIPATION IS VOLUNTARY. Your child has the right not to be in this evaluation or to stop being in the evaluation at any time. Choosing not to fill out the survey will not affect his/her ability to take part in any program or activity, or his/her grades in school. If you have any questions, or would like to see a blank copy of the survey, please call (contact name) from (school or agency name) at (phone number).

MARK ONE ANSWER AND RETURN TO (name/location) by (date)  I give my consent for my child to take part in this evaluation.  I do NOT give my consent for my child to take part in this evaluation. Child’s Name: (Please print your child’s name)

Parent: Parent/Guardian (please print)

THANK YOU FOR YOUR CONSIDERATION

6-2014

Signature of Parent/Guardian

Date

ACTIVE CONSENT_TEMPLATE EVALUACIÓN DE RESPONSABILIDAD PERSONAL Y DEL PROGRAMA DE EDUCACIÓN Investigador principal: Claire Brindis, DrPH Universidad de California, San Francisco ¿Qué es la Evaluación de Responsabilidad Personal y del Programa de Educación? Esta es una evaluación dirigida por la Dra. Claire Brindis de la Universidad de California, San Francisco. Esta evaluación es financiada por la Oficina de Servicios Familiares y de Jóvenes bajo la dirección del Programa de Salud Materna, Infantil y de Adolescentes del Estado de California. Esta es una encuesta para evaluar cuán bien los programas de educación/salud sexual educan a los jóvenes sobre el embarazo entre los adolescentes. Unas preguntas son sobre el propio comportamiento sexual de su hijo. La participación es voluntaria. Se le pide a su hijo que participe de la encuesta porque este año participa en un programa de educación/salud sexual. El objetivo de esta evaluación es saber más sobre qué piensan los jóvenes y qué aprendieron en sus programas de educación/salud sexual. Aproximadamente 16,000 jóvenes en California participarán en esta evaluación. ¿Mi hijo tiene que participar? No. La participación en la evaluación es voluntaria. Incluso si usted da su permiso, su hijo puede saltear preguntas o decidir no completar la encuesta. Si su hijo decide no participar en la encuesta, esto no afectará su participación en ningún programa o actividad ni sus notas en la escuela. Si decide que su hijo no debería participar, o si su hijo elige no hacerlo, la persona que entrega la encuesta o el maestro de su hijo le dará a su hijo otra actividad para realizar durante la encuesta. ¿Qué sucederá si mi hijo participa en la evaluación? Su hijo completará una encuesta dos veces, una vez al comienzo del programa y otra vez una vez que se finalice el programa. Completar la encuesta tomará unos 10 minutos. ¿Cómo se mantiene la privacidad de las respuestas de mi hijo? Esta encuesta es anónima; el nombre de su hijo no aparecerá en la encuesta. No hay ninguna otra forma en que se puedan relacionar las respuestas con su hijo. Si la información de esta evaluación se publica o presenta en reuniones científicas, no se usarán nombres ni información personal. ¿Qué riesgos puede esperar mi hijo por participar en la evaluación? La participación en este proyecto presenta un riesgo mínimo. No se usarán nombres en ningún informe sobre esta evaluación. Su hijo puede sentirse incómodo leyendo o respondiendo a las preguntas sobre actividad sexual. Su hijo no tiene que responder preguntas si no lo desea. Si su hijo decide que no participará la encuesta, no afectará su posibilidad de participar en el programa o actividad, y no afectará sus notas. ¿Hay algún beneficio por participar en la evaluación? No habrá ningún beneficio directo por la participación de su hijo. Sin embargo, los resultados de la encuesta pueden ayudar a los profesionales de la salud a mejorar los programas educativos destinados a reducir el embarazo entre los adolescentes. ¿Tiene algún costo participar en esta evaluación? ¿Le pagarán a mi hijo por participar? No hay cargo alguno por participar en esta evaluación. Su hijo no recibirá ningún pago por participar en esta evaluación. ¿Qué sucede si tengo comentarios o dudas sobre la participación de mi hijo en la evaluación? Si tiene comentarios o dudas sobre la participación de su hijo en esta evaluación, deberá hablar primero con los educadores de salud que distribuyen la encuesta: (nombre de contacto, nombre de la escuela o agencia, número de teléfono). Puede llamar también a la Dra. Claire Brindis, Investigadora Principal, al (415) 476-3375 en la Universidad de California, San Francisco. Puede llamar con cobro revertido. Participar en esta evaluación es su elección y la de su hijo. Usted y su hijo pueden elegir participar o no. No importa la decisión que tome, no habrá ningún tipo de penalidad para usted o su hijo. Vea la Carta de Derechos de los Participantes de una Investigación para más información. 6-2014

EVALUACIÓN DE RESPONSABILIDAD PERSONAL Y DEL PROGRAMA DE EDUCACIÓN Investigador principal: Claire Brindis, DrPH Universidad de California, San Francisco

Formulario de Consentimiento de Padres/Tutor Estamos pidiendo su permiso para permitir que su hijo participe en una evaluación del programa de educación/salud sexual. La evaluación la realizará la Dra. Claire Brindis de la Universidad de California, San Francisco y está auspiciada por el Departamento de Salud Pública de California. La evaluación consiste en una encuesta sobre la salud de su hijo. Las preguntas de la encuesta cubren temas como actividad sexual, relaciones sanas, violencia entre parejas, conocimiento de salud y servicios reproductivos, y opiniones sobre el programa. Unas preguntas son sobre el propio comportamiento sexual de su hijo. El personal del proyecto entregará la encuesta. Los resultados de la encuesta nos ayudarán a determinar si el programa tiene éxito en la educación de los jóvenes sobre el embarazo adolescente. Si no desea que su hijo complete la encuesta, igual tendrá derecho a participar en el programa. NO HAY NOMBRES EN LA ENCUESTA. No se pedirá que su hijo ponga su nombre en la encuesta. LA PARTICIPACIÓN ES VOLUNTARIA. Su hijo tiene el derecho a no participar en esta evaluación o a dejar de participar en cualquier momento. Si elige no completar la encuesta, la capacidad de su hijo de participar en el programa o actividad, ni las notas en la escuela se verán afectadas. Si tiene preguntas, o desea ver una copia en blanco de la encuesta, por favor llame a (nombre de contacto) de (nombre de la escuela o agencia) al (número de teléfono).

MARQUE UNA RESPUESTA Y DEVUELVA a (nombre/ubicación) antes de (fecha)  Doy mi consentimiento para que mi hijo participe en esta evaluación.  NO doy mi consentimiento para que mi hijo participe en esta evaluación. Nombre del niño: (Por favor escriba el nombre del niño en imprenta)

Padre: Padre/Tutor (en imprenta)

¡GRACIAS POR SU CONSIDERACIÓN!

6-2014

Firma del Padre/Tutor

Fecha

Attachment D: Cover Sheet (Participant Verbal Assent) for Juvenile Justice Facilities

General Instructions Thank you for your help with this important study. It will help us understand what things are like for people your age today and help to identify effective ways to reduce risk behaviors. This survey includes questions about your family, friends, school, and also your attitudes and behaviors. Your answers and everything you say will be kept private. Your name will not be on the survey. Please answer all questions as well as you can.

We want you to know that: 1. Your participation in this survey is voluntary. 2. We hope that you will answer all the questions, but you may skip any questions you do not wish to answer.

3. The answers you give will be kept private. Your responses will be combined with those of other people your age.

4. Choosing to take part or not take part will have no effect on your parole or probation.

5. Parole boards will not know whether or not you participate and will not take this into account when making decisions regarding your parole.

PLEASE READ EACH QUESTION CAREFULLY: There are different ways to answer the questions in this survey. It is important that you follow the instructions when answering each kind of question. • •

PLEASE MARK ALL ANSWERS WITHIN THE WHITE BOXES PROVIDED. USE A PEN OR PENCIL.

Instrucciones Generales

Gracias por tu ayuda con este importante estudio. Nos ayudara a entender qué tal son las cosas para personas de tu edad hoy y ayudara a identificar formas efectivas para reducir comportamientos de riesgo. Esta encuesta incluye preguntas sobre tus compañeros y compañeras, tu escuela, metas para el futuro y también tus actitudes y comportamiento. Tus respuestas y todo lo que digas se mantendrá privado. Tu nombre no aparecerá en la encuesta. Por favor contesta a todas las preguntas lo mejor que puedas. Queremos que sepas que: 1.

Tu participación en esta encuesta es voluntaria.

2.

Tenemos la esperanza que contestarás todas las preguntas, pero puedes saltar las preguntas que no deseas contestar.

3.

Las respuestas que nos darás se mantendrán privadas. Tus respuestas serán combinadas con las de otras personas de tu edad.

4.

La elección de participar o no participar no tendrá ningún efecto sobre su libertad condicional o libertad provisional.

5.

La comisión de libertad no sabrá si participas o no y no tomarán esto en cuenta a la hora de tomar decisiones acerca de tu libertad condicional.

POR FAVOR LEE CADA PREGUNTA CON CUIDADO: Hay diferentes formas de contestar las preguntas en esta encuesta. Es importante que sigas las instrucciones cuando contestas a cada tipo de pregunta.

•

POR FAVOR MARCA TODAS LAS RESPUESTAS DENTRO DE LAS CASILLAS EN BLANCO PROPORCIONADAS.

•

USA UN LAPICERO/BOLÍGRAFO O UN LÁPIZ.

Attachment E: Participants’ Bill of Rights (English/Spanish)

Participant’s Bill of Rights for Non-Medical Research You have been asked to participate in a research study. Any participant in a research study has the right to: a. Be told the nature and purpose of the study. b. Be given an explanation of what will happen during the study and of how the research participant is expected to participate. c. Be given an explanation of any risks or discomforts that may be experienced as a result of participating in the study. d. Be given an explanation of any benefits that may be expected from participation in the study. e. Be told of other appropriate choices that may be better or worse than being in the study, and be told of the risks and benefits of those other choices. f.

Have the opportunity to ask questions about the study or about your participation in it, both before agreeing to participate in the study and during the course of the study.

g. Be told that you may withdraw your consent and participation in the study at any time, and that your withdrawal will not affect your services. h. Be told that you may refuse to answer any question. i.

Be given a copy of the information sheet (cover sheet of survey) to keep. .

j.

Be free of pressure when considering whether to consent to, and participate in, the study.

k. Be informed, upon request, about the results of the study.

Revised 6-27-13

Declaración de Derechos de Participantes en Estudios No Medicos (Spanish translation of Participant’s Bill of Rights for Non-Medical Research) Se le ha pedido que participe en un estudio de investigación. Cualquier participante en un estudio de investigación tiene el derecho a: a. Que se le diga la naturaleza y el propósito del estudio. b. Que se le dé una explicación de lo que ocurrirá durante el estudio y de que manera se espera que participe el participante en una investigación. c. Que se le dé una explicación de todos los riesgos o molestias que pueden ocurrir como resultado de la participación en el estudio. d. Que se le dé una explicación de todos los beneficios que se pueden recibir de la participación en el estudio. e. Que se le diga de otras alternativas apropiadas que pudieran ser mejores o peores que la participación en el estudio, y que se le diga de los riesgos y beneficios de esas otras alternativas. f.

Que tenga la oportunidad de hacer preguntas acerca del estudio o acerca de su participación en el estudio, antes de participar en el estudio y durante la duración del estudio.

g. Que se le diga que puede retirar su consentimiento y participación en el estudio en cualquier momento, y que su retiro no le afectará sus servicios. h. Que se le diga que puede rehusarse a contestar cualquier pregunta. i.

Que se le dé una copia de la hoja informativa (la primera hoja de la encuesta) para mantener.

j.

Estar libre de presiones al momento de decidir si da su consentimiento para participar en el estudio.

k. Obtener información, en cuanto usted lo pida, acerca de los resultados del estudio.

(Traducido por J. Ruiz)

Revised 6-27-13

Attachment F: Survey Summary Forms (Entry and Exit)

California PREP – ENTRY SURVEY SUMMARY FORM INSTRUCTIONS: Complete ONE Entry Survey Summary Form for each batch of completed ENTRY surveys PER COHORT. Complete a separate Entry Survey Summary Form for Newcomer Entry Surveys. Submit completed ENTRY surveys and Survey Summary Form by mail to your assigned Evaluation Liaison (please use the pre-addressed mailing labels provided to you). Please complete all information requested on this form. If you have questions about the survey or questions about how to complete this form, contact your Evaluation Liaison. Program and Cohort Information 1. Agency Number (two-digit number): ______ 2. Agency Name: ______________________________ 3. Cohort Number (from your approved EBPM Planning Calendar): _________________ 4. Survey administered in a middle school setting?  Yes

 No

Survey Information 5. What type of surveys are you submitting (please check one) and provide the date(s) of survey: a.  Initial Entry Surveys • Date of Entry Survey Administration:__________________________ b.  Newcomer Entry Surveys • Date (s) of Newcomer Entry Surveys Administration: ________________, ________________, _____________, _______________ 6. Total Number of Entry Surveys a. Number of English Entry Surveys: ___________ b. Number of Spanish Entry Surveys: ___________ 7. Number of participants who did not take surveys due to: a. Language/Literacy challenges: ________ (Do not leave blank, indicate “0” if there were no challenges) b. Participant refusal: __________ (Do not leave blank, indicate “0” if there are no participant refusals) 8. Number of Parent Refusals: _____________ (Do not leave blank, indicate “0” if there are no parent refusals) 9. Name of Survey Administrator(s): __________________________ ______________________ 10. Notes (document any circumstances surrounding the survey administration that might affect participation in the survey, such as distractions, noise, privacy, protocol violations, language/literacy challenges, etc.).

_____________________________________________________________________________________ _____________________________________________________________________________________ 11. Please provide the name and contact information for the person who can provide additional information about the surveys completed for this cohort if needed. Name of Contact : ____________________ Email

: ____________________

Phone : (

) ______ -_____________

For Internal Official Use: Verified by:

Date Verified:

Date Logged on Survey Tracking Log :

California PREP – EXIT SURVEY SUMMARY FORM INSTRUCTIONS: Complete ONE Exit Survey Summary Form for each batch of completed EXIT surveys PER COHORT. Submit completed EXIT Surveys and Survey Summary Form by mail to your assigned Evaluation Liaison (please use the pre-addressed mailing labels provided to you). Please complete all information requested on this form. If you have questions about the survey or questions about how to complete this form, contact your Evaluation Liaison. Program and Cohort Information 1. Agency Number (two-digit number): ______ 2. Agency Name: ______________________________ 3. Cohort Number (from your approved EBPM Planning Calendar): _________________ 4. Survey administered in a middle school setting?  Yes

 No

Survey Information 5. Total Number of Exit Surveys a. Number of English Exit Surveys: ___________ b. Number of Spanish Exit Surveys: ___________ 6. Number of participants who did not take surveys due to: a. Language/Literacy challenges: ________ (Do not leave blank, indicate “0” if there were no challenges) b. Refusals: __________ (Do not leave blank, indicate “0” if there are no participant refusals) 7. Date of Exit Survey Administration: _____________________ 8. Name of Survey Administrator(s): __________________________ ____________________________ 9.

Notes (e.g., document any circumstances surrounding the survey administration that might affect participation in the

survey, such as distractions, noise, privacy, protocol violations, language/literacy challenges, etc.).

_____________________________________________________________________________________ _____________________________________________________________________________________ 10. Please provide the name and contact information for the person who can provide additional information about the surveys completed for this cohort if needed. Name of Contact : ____________________ Email

: ____________________

Phone : (

) ______ -_____________

For Internal Official Use: Verified by:

Date Verified:

Date Logged on Survey Tracking Log :

Appendix G: Entry Survey Administration Protocol

Entry Survey Administration Protocol NOTE: Instructions to be read aloud to the participants are in bold type in shaded boxes. Instructions for the survey administrators are in plain type. You may want to tell participants that you will be reading the introduction so you don’t forget anything important. Self Introduction 1. Briefly introduce yourself (speak clearly and loudly): Good morning/afternoon. My name is _______________ and this is __[name of your co-facilitator if you have one]_________. We work for [name of agency]. We will be implementing a program called [Name of EBPM].[May also want to add in a few other features of the program—i.e., number of sessions, days of week, etc.] Survey and Program Introduction 2. Introduce the study and survey. This program is part of a Federal program called the Personal Responsibility and Education Program (PREP). As part of this program, we are going to ask you to take part in completing a survey before the program starts (Entry Survey) and another one at the end of the Program (Exit Survey). These will help us find out how what you think and what you learned from taking part in this sex education/health program [insert name of program]. This survey is not a test, and you will not be graded on how you answer the questions. These surveys are anonymous. That means that no one – not your parents/guardians/foster parents, friends, or teachers will see your responses to the surveys. Do not put your name on the survey. Your parents/guardians can decide whether or not they want you to take the survey. Some of you may not be taking the survey today, and will work quietly at your seats. 3. Pass out alternative activity to those participants not taking the survey or ask them to work quietly at their desks/seats. Participant’s Bill of Rights, Verbal Assents and Survey Distribution 4. Continue with: We will only give you this survey if you agree to take it. I am going to pass out a document, called the Participant’s Bill of Rights, that describes the survey, tells you your rights, and gives you the choice to take the survey or not. This copy is for you to keep. We hope that you will choose to take the survey because your answers will really help us. You will still be able to participate in the [SAY NAME OF PROGRAM] if you decide not to take the survey. Please put away all other materials. If surveying in school/community settings (non juvenile justice facilities)  Give a copy of the Participants’ Bill of Rights and the entry survey ONLY to participants with appropriate parent/guardian consent. DO NOT ask anyone to help you hand out the surveys.  Next, read the survey cover sheet (Participant verbal assent) aloud to the class. Ask participants to follow along as you read. Instruct the participants that you will be reading the cover sheet out loud.

Read the cover sheet out loud (School/Community Settings) Thank you for your help with this important study! It will help us understand what things are like for people your age today and help to identify effective ways to reduce risk behaviors. This survey includes questions about your family, friends, school, and also your attitudes and behaviors. Your answers and everything you say will be kept private. Your name will not be on the survey. Please answer all the questions as well as you can. We want you to know that: • Your participation in this survey is voluntary. • We hope that you will answer all of the questions, but you may skip any questions you do not wish to answer. • The answers you give will be kept private. Your responses will be combined with those of other people your age. Please read each question carefully. There are different ways to answer the questions in this survey. It is important that you follow the instructions when answering each kind of question. Please mark all answers within the white boxes provided. Use a pen or pencil. If you agree to take the entry survey, please tear off the cover sheet. This copy is yours to keep. If you do not agree to take entry survey, please turn over the entry survey booklet on your desk and take out an alternative activity while the others are taking the survey. I will collect the blank entry surveys. If surveying in juvenile justice facilities  Give a copy of the Participants’ Bill of Rights, the cover sheet (alternate version, Attachment D), and the entry survey ONLY to participants with appropriate parent/guardian consent. DO NOT ask anyone to help you hand out the surveys.  Next, read the survey cover sheet page (alternate version) aloud to the class. Ask participants to follow along as you read. Instruct the participants that you will be reading the cover sheet out loud. Cover Sheet for Juvenile Justice Facilities (Alternate version) Thank you for your help with this important study! It will help us understand what things are like for people your age today and help to identify effective ways to reduce risk behaviors. This survey includes questions about your family, friends, school, and also your attitudes and behaviors. Your answers and everything you say will be kept private. Your name will not be on the survey. Please answer all the questions as well as you can. We want you to know that: • Your participation in this survey is voluntary. • We hope that you will answer all of the questions, but you may skip any questions you do not wish to answer. • The answers you give will be kept private. Your responses will be combined with those of other people your age. • Choosing to take part or not take part will have no effect on your parole or probation. • Parole boards will not know whether or not you participate and will not take this into account when making decisions regarding your parole. Please read each question carefully. There are different ways to answer the questions in this survey. It is important that you follow the instructions when answering each kind of question. Please mark all answers within the white boxes provided. Use a pen or pencil. If you agree to take the entry survey, please tear off the cover sheet. This copy is yours to keep. You may start the survey. If you do not agree to take Entry Survey, please turn over the Entry survey booklet on your desk and take out an alternative activity while the others are taking the survey. I will collect the blank Entry Surveys.

5. If a participant refuses to complete the survey, do not insist that the participant agree to take the survey. Instead, keep the survey and indicate on the survey summary form the number of participants who refused to complete the survey. If a participant is unable to take the survey due to language or literacy issues, collect the survey and indicate on the survey summary form the number of participants who were unable to complete the survey because of this issue. 6.

Continue with:

We want your answers on this survey to be private. Therefore, we will maintain strict procedures to make sure you have privacy. Please do not walk around the room until all the surveys are collected, and do not look at any one else's survey. If you have a question, raise your hand and I will come to your seat. When you have finished your survey, please turn your completed survey over and place your pen/pencil on the desk. I will collect the surveys all at once. 7. Once you have administered the entry survey, refer back Section 5 (What do I do the day of the survey) and continue following the guidelines under step four.

Attachment H: Exit Survey Administration Protocol (Revised August, 2014)

Exit Survey Administration Protocol NOTE: Instructions to be read aloud to the participants are in bold type in shaded boxes. Instructions for the survey administrators are in plain type. You may want to tell participants that you will be reading the introduction so you don’t forget anything important. Self Introduction 1. Briefly introduce yourself (speak clearly and loudly): Good morning/afternoon. My name is _______________ and this is __[name of your co-facilitator if you have one]_________. We work for [name of agency]. We are going to give you the end-of-program survey called the Exit Survey. Survey and Program Introduction 2. Introduce the survey. The exit survey is part of a Federal program called the Personal Responsibility and Education Program (PREP). The exit survey is similar to the entry survey that you took at the beginning of the program and has additional questions about information you learned in the program and what you thought of the program. These will help us find out how what you think and what you learned from taking part in this sex education/health program [SAY NAME OF PROGRAM]. This survey is not a test, and you will not be graded on how you answer the questions. These surveys are anonymous. That means that no one – not your parents/guardians/foster parents, friends, or teachers - will see your responses to the surveys. Do not put your name on the survey. Your parents/guardians can decide whether they want you to take the survey. Some of you may not be taking the survey today. Some of you may not be taking the survey today, and will work quietly at your seats. 3. Pass out alternative activity to those participants not taking the survey or ask them work on a quiet activity at their desks/seats. FOR EXIT SURVEY IN MIDDLE SCHOOL ONLY If surveying middle school grades 4 to 8 (in school based settings), pass out Participants’ Bill of Rights We will only give you this survey if you agree to take it. I am going to pass out a document, called the Participant’s Bill of Rights, that describes the survey, tells you your rights, and gives you the choice to take the survey or not. This copy is for you to keep. We hope that you will choose to take the survey because your answers will really help us. You will still be able to participate in the [SAY NAME OF PROGRAM] if you decide not to take the survey. Please put away all other materials.

Participant Verbal Assents and Survey Distribution 4. Continue with: I am going to pass out a letter that describes the survey, tells you your rights, and gives you the choice to take the survey or not. We hope that you will choose to take the survey because your answers will really help us. If surveying in school/community settings (non juvenile justice facilities)  Give a copy of the exit survey ONLY to participants with appropriate parent consent. DO NOT ask anyone to help you hand out the surveys.  Next, read the cover sheet (Participant Verbal Assent) aloud to the class. Ask participants to follow along as you read. Instruct the participants that you will be reading the cover sheet out loud. Read the cover sheet out loud (School/Community Settings) Thank you for your help with this important study! It will help us understand what things are like for people your age today and help to identify effective ways to reduce risk behaviors. This survey includes questions about your family, friends, school, and also your attitudes and behaviors. Your answers and everything you say will be kept private. Your name will not be on the survey. Please answer all the questions as well as you can. We want you to know that: • Your participation in this survey is voluntary. • We hope that you will answer all of the questions, but you may skip any questions you do not wish to answer. • The answers you give will be kept private. Your responses will be combined with those of other people your age. Please read each question carefully. There are different ways to answer the questions in this survey. It is important that you follow the instructions when answering each kind of question. Please mark all answers within the white boxes provided. Use a pen or pencil. If you agree to take the entry survey, please tear off the cover sheet. This copy is yours to keep. If you do not agree to take the exit survey, please turn over the survey booklet on your desk and take out an alternative activity while others are taking the survey. I will collect the black exit surveys.

If surveying in juvenile justice facilities  Give a copy of the cover sheet (alternate version, Attachment D), and the entry survey ONLY to participants with appropriate parent/guardian consent. DO NOT ask anyone to help you hand out the surveys.  Next, read the survey cover sheet page (alternate version) aloud to the class. Ask participants to follow along as you read. Instruct the participants that you will be reading the cover sheet out loud. Cover Sheet for Juvenile Justice Facilities (Alternate version) Thank you for your help with this important study! It will help us understand what things are like for people your age today and help to identify effective ways to reduce risk behaviors. This survey includes questions about your family, friends, school, and also your attitudes and behaviors. Your answers and everything you say will be kept private. Your name will not be on the survey. Please answer all the questions as well as you can. We want you to know that: • Your participation in this survey is voluntary. • We hope that you will answer all of the questions, but you may skip any questions you do not wish to answer. • The answers you give will be kept private. Your responses will be combined with those of other people your age. • Choosing to take part or not take part will have no effect on your parole or probation. • Parole boards will not know whether or not you participate and will not take this into account when making decisions regarding your parole. Please read each question carefully. There are different ways to answer the questions in this survey. It is important that you follow the instructions when answering each kind of question. Please mark all answers within the white boxes provided. Use a pen or pencil. If you agree to take the exit survey, please tear off the cover sheet. This copy is yours to keep. If you do not agree to take exit survey, please turn over the exit survey booklet on your desk and take out an alternative activity while the others are taking the survey. I will collect the blank exit surveys. 5. If a participant refuses or does not provide verbal assent, do not insist that the participant agree to take the survey. Instead, keep the survey and indicate on the Survey summary form the number of participants who refused to complete the survey. If a participant is unable to take the survey due to language or literacy issues, collect the survey and indicate on the survey summary form the number of participants who were unable to complete the survey because of this issue. 6. Continue with: We want your answers on this survey to be private. Therefore, we will maintain strict procedures to make sure you have privacy. Please do not walk around the room until all the surveys are collected, and do not look at any one else's survey. If you have a question, raise your hand and I will come to your seat. When you have finished your survey, please turn your completed survey over and place your pen/pencil on the desk. I will collect the surveys all at once. 7. Once you have administered the exit survey, refer back Section 5 (What do I do the day of the survey) and continue following the guidelines under step four.

Attachment I: Survey Administration Considerations and Tips

SURVEY ADMINISTRATION CONSIDERATIONS AND TIPS Each setting in which you administer the CA PREP entry and exit survey may react in a different way or have different requirements to follow. The following information provides important reminders and tips for you while interacting with participants, teachers and other personnel in the setting in which you are implementing your program. Participant Confidentiality The entry and exit survey contains questions of a sensitive nature. Please adhere to the following guidelines to insure privacy and confidentiality, which help create an atmosphere for participants to answer honestly: 1. Keep both completed and blank surveys in your possession at all times. 2. Do not allow teachers or other personnel to look at a blank survey in sight of participants, and NEVER allow teachers or other personnel to look at completed surveys. Other participants also may NEVER look at someone else’s completed survey. 3. Do not allow teachers, other personnel, or participants to walk around the room during survey administration. 4. Try not to walk around the room during survey administration, unless it is to answer an individual participant’s question or manage disruptive behavior. 5. Make sure that you have collected ALL survey materials before leaving the classroom/location. This includes completed surveys, cover sheets and ALL UNUSED materials. Do not leave or dispose of any survey related materials in the classroom/location. 6. If participants begin to whisper or talk during the administration, remind them either individually or as a class to work quietly until everyone has finished. Ignore participants who do not seem to be filling out the survey or who seem to be quickly completing the survey without reading it. 7. If a participant starts looking at another participant’s survey, motion with your hand and eyes to keep his/her eyes on his/her own survey. You also may need to make a general announcement to the group reminding everyone that they should be working individually. 8. Do not pick up surveys until all participants have completed them. Ask participants to keep surveys on their desks until everyone has finished. 9. Do not initiate or encourage discussion with the teacher. Whispering may annoy or distract participants while they are completing the survey. Try moving to another location in the room or look busy (e.g., by reading your manual) to discourage the teacher from talking with you.

Voluntary Participation and Refusals The entry and exit surveys are voluntary. Participants may refuse to fill out specific items on the entry and exit surveys or they may choose not to take the surveys at all. It is important for all participants to know that completing the entry/exit survey should never be a condition for participation in your program. If participants decide to complete the survey, they can decide to skip any question that makes them uncomfortable. Some questions are of a sensitive nature and participants may feel more comfortable participating in the survey if they know they do not have to answer all of the questions. 1. If a participant says that s/he does not want to fill out the entry/exit survey, accept this and do not give that participant the survey. 2. Participants should not be asked for a reason for their refusal.

3. If a participant asks, "Do I have to do this?" explain that participation is voluntary. 4. If s/he decides not to do it, accept this decision and provide the participant with an alternative activity that won’t disrupt the larger group (e.g., reading). 5. If a participant gets up and walks out of the room, do not try to stop the participant. Let the host teacher or other adult from the non-school setting handle the situation. 6. Make sure you explain to the host teacher/other personnel about the voluntary nature of these surveys. Host teachers/other adults also need to abide by these guidelines and should not pressure or force participants to complete the surveys.

Answering Participants’ Questions Participants may ask questions pertaining to the general nature of the entry and exit surveys. Feel free to answer these questions if you are confident of your answers. Otherwise, refrain from answering. The administration instructions you give at the beginning of the data collection will indicate that participants who have questions during the survey administration should raise their hands so that you can answer questions individually. When answering questions, follow these general rules: 1. Because time allotted for completing the entry and exit surveys is limited, do not encourage questions and answers in front of the entire group. Tell the participants that you will come to where they are seated and answer their questions individually. 2. When responding to individual questions during survey administration, you can read an item or pronounce a word. Sometimes when participants hear the pronunciation of a difficult word they will know its meaning. 3. You may also restate or clarify an item; however, never clarify an item in a way that may imply a preferred or correct answer. Don't suggest that a participant mark a particular answer based on what the participant says to you about his/her behavior. Provide appropriate clarifications, but let participants make the final decision of what to mark. 4. Never give participants the answers to items on the survey. 5. Walk away before he/she records a response. 6. If you are unsure how to answer a particular question, don’t answer it. Tell the participant that you cannot answer the question, and ask them to do the best they can. 7. If participants are generally curious about the material, encourage them to ask you after all surveys have been collected.

Answering Host Teacher/Other Adult Questions If the host teacher/other adult asks to see a copy of the entry or exit survey, explain that once the survey is over, they will be able to review a blank copy of the survey. Explain that participants will be unable to tell whether a survey is blank or completed, and that having someone view the survey during the administration may raise questions in participants' minds about whether their answers are private. Also, in order to maintain the integrity of the evaluation, the survey materials must remain private until all data have been collected. Under no circumstances should you allow anyone to see any of the completed surveys.

Tips for Reading Surveys Aloud You may serve participants who need additional assistance reading the survey questions and response options. Sometimes you may know ahead of time and can plan for accommodations. Please follow these general guidelines when reading surveys aloud. 1. Find a location that is unobtrusive so that your reading does not distract the other participants and the participant (s) being read to does not feel conspicuous. 2. Make sure the participant has a blank sheet of paper (or they can use the cover sheet) to cover his/her answers. 3. Tell the participants you will not look at his/her answers. 4. Be very careful that you do not give away the answers in the way you read the questions or the answer choices. Read each question and answer choice verbatim from the survey. DO NOT PARAPHRASE. 5. You should have read the entire survey at least once prior to your first administration so you are familiar with the wording of the items. 6. Prior to administration, tell the participants to let you know if he/she needs anything repeated; otherwise, read everything only once and do not ask the participant if he/she needs anything repeated. 7. Prior to administration, tell the participant to cover he/her completed answers and to put his/her pencil down after each question; this will tell you that he/she is ready to move on to the next item. You might need to remind the participant to do this for the first few times. 8. After items 5 and 10, check to see if you are readying too slow, fast, quietly, etc. Remind the participant again to let you know if he/she needs anything repeated. 9. Based on how much time it takes to read the survey aloud, the participant may or may not finish the whole survey in the time allotted. That is OK. Advise the participant to think about time and to move on from any item with which he/she is having trouble. Important Reminder: Following the Entry and Exit survey administration protocol as outlined in Attachments G &H to secure participant verbal assent (DO NOT SKIP THIS STEP). You may follow-up with:  I am going to read each item and answer choice to you. After I read each item and answer choice, you can take as much time you need to answer the item. If you need me to read anything again, please let me know. Otherwise, I will ready everything only one time. I will not be looking at your answers, you can use the cover sheet from the survey to cover your responses. Please put your pencil down after you complete each answer. That will let me know it is time to move on to the next item.  Please let me know at any time if I am reading too slow or too fast. I cannot answer for you; just do the best you can. Remember this is not a test. If you are unable to answer a question, feel free to move on to the next question and come back to the question you skipped if you have time. Do you have any questions?