1. ANDREW WOODRUFF NV QTAC PROGRAM MANAGER SHARON GOLDSTROHM NV QTAC PROGRAM COORDINATOR DAWN GENTSCH NV QTAC PROGRAM CONSULTANT Healthy Living: Up2Me Nevada Quality and Technical Assistance Center 2014 Survey Packet Training

2. Overview  NV QTAC requests your utilization of the HLU2M Program data collection forms and procedures that meet the necessary standards.  Use of forms is now a requirement for Nevada Lay Leaders and Nevada organizations implementing CDSME and DSME programs under the Stanford License held by NV QTAC.  Start utilizing immediately.  Must train personnel and start using updated forms by 05.01.14. 2

3. 3 Tips for Evaluation Paperwork

4. Process Overview 4 Lay Leader Training Leader training and requirements (1 workshop in 6 mon) Leader agreement form with NV QTAC or organization you are under NVQTAC HLU2M Survey Packet Training and PII/Security Training (webinar & test) Pre- Workshop HLU2M workshop marketing, workshop flyer templates Participant workshop consent/registration form (keep secure) Workshop information form to HLU2M Facilitator Non-Disclosure Agreement Workshop Pre/post surveys – each participant (keep secure) Welcome Letter (Leaders read at 1 st class to workshop participants) Attendance Log, Workshop Tracking Form Post Workshop Workshop cover sheet Material to NVQTAC OR your organization is authorized for Data Portal Data used for annual report to Stanford University for NV QTAC license or by the organization’s license you are under. Helps with grants and overall program impact to improve the health of people in Nevada!

5. 5 All found on NVHealthyliving.org Overview of all the forms included in the Survey Packet For each Form  Description  Purpose  How to use About this Survey Packet

6. Updated Evaluation Tools 6  About This Survey Packet  Data Collection Cheat sheet  Workshop Information Form  Facilitator Non- Disclosure Agreement  Welcome Letter  Consent Letter  Attendance Log  Participant Consent/Registration Form  Participant Survey  Pre and post  Workshop Tracking Form  Submitted with final paperwork  Workshop Cover Sheet  Submitted with other workshop materials

7. Workshop Information Form 7 Without this form we will not know a workshop is going to happen or is in progress Please download/print/scan/email What do I need to know to fill it out?  Location  Times/Dates  Licensing information  Registration contacts

8. Workshop Marketing Flyer 8 Workshop flyers are available for: -CDSMP -DSMP -Spanish versions available soon! Insert -your organization’s logo -workshop start and end date -workshop location, address, and city -registration contact information (name, phone, email, website) -Last date to register

9. Welcome and Consent Letters 9 Welcome Letter REQUIRED to read aloud  If necessary due to challenges, may be handed to participants Explains how participant privacy is protected and why data is being collected (the evaluation process) For information purposes only Consent/Registration Form Without this letter signed, no data will be submitted! Even data that is submitted is shredded without a consent! These Form Letters include a space for printed name

10. Facilitator Non-Disclosure Agreement 10 New Form Must be filled out prior to workshop start One agreement form per facilitator Substitutes (leaders) must also sign Similar language to what is included in Lay Leader Agreement document with NVQTAC

11. Attendance Log 11 Names on attendance log must correspond with names on surveys and consent forms  Can use a nickname Filled out by facilitators Must be legible “X” for Present “A” for Absent

12. Pre and Post Surveys 12 Two pages/survey  May be copied double- sided Responding to each question Check to make sure survey is completed PRE and POST surveys are in English and Spanish for CDSMP and DSMP Enter data into the Data Portal

13. Workshop Cover Sheet 13 Submitted with the Attendance Log and PRE & POST surveys at the end of a workshop  Within 2 weeks Indicate type of workshop Explain missing or excluded paperwork Use the checklist on page 2

14. Workshop Tracking Form 14 Useful for keeping track of participant’s paperwork Optional Does not need to be submitted to Institute

15. Thank You! Andrew Woodruff NV QTAC Program Manager 775. 887.0417 awoodruff@nvpca.org Sharon Goldstrohm NV QTAC Program Coordinator sgoldstrohm@nvpca.org Dawn Gentsch NV QTAC Program Consultant 515.360.1731 dgentsch@nvpca.org 15

16. 16 Questions?