School Mental Health Project

Impact Evaluation

The Center is trying to determine the impact of our work.

Please take a few minutes to help us out by providing us with feedback.

EVEN PARTIAL RESPONSES WILL BE HELPFUL!

IF YOU CHOOSE NOT TO PROVIDE FEEDBACK, IT WILL STILL HELP US IF YOU SEND BACK THIS PAGE WITH THE FOLLOWING IDENTIFYING DATA FILLED OUT

Your Name:
Title:
Agency/Address:
 Private? Public?
City:
 State:
 Zip:
Phone:
 Fax:
 E-Mail

Frequency and nature of contact with Center?
My contact has been of a casual nature (e.g., receive newsletter)
I have been in frequent contact (e.g., for TA, for resources, etc.)
I use the Center for strategic assistance (e.g., to help improve programs, systems, etc.)

Do you want to be dropped from our mailing list? Yes No

USEFULNESS
How useful were any of these resources to you? (check rating)

TA/Consultation Quite a Bit Somewhat A Little Not At All Not used
Policy Reports Quite a Bit Somewhat A Little Not At All Not used
Other Resource Materials* Quite a Bit Somewhat A Little Not At All Not used
Electronic Newsletter (ENEWS) Quite a Bit Somewhat A Little Not At All Not used
Quarterly Hardcopy Newsletter Quite a Bit Somewhat A Little Not At All Not used
Practitioners's Listserv Quite a Bit Somewhat A Little Not At All Not used
Work Related to New Directions for Student Support Quite a Bit Somewhat A Little Not At All Not used
Other Networking** Quite a Bit Somewhat A Little Not At All Not used
Support for Programs and/or Initiatives Quite a Bit Somewhat A Little Not At All Not used
Support for Systemic Changes Quite a Bit Somewhat A Little Not At All Not used
*Other Resource Materials -- refers to resource packets and aids, fact sheets, practice notes, guidebooks, concept papers, statements of principles and guidelines, critical issue and policy reports, continuing education modules, special training aids, published articles, chapters, and books, products related to research and development.
**Networking -- refers to opportunities created by the Center for Interacting at regional and national meetings, through participation in coalitions and special cadres, through Center operated listservs, through task workgroups and other collaborative connections, etc.

IMPACT
Degree of our Center's impact on any of your job functions
(Check, then rate any of the following functions that are part of the work you do)

TA/Consultation Quite a Bit Somewhat A Little Not yet N/A
Program Development Quite a Bit Somewhat A Little Not yet N/A
Direct Practice Quite a Bit Somewhat A Little Not yet N/A
Influencing Policy Quite a Bit Somewhat A Little Not yet N/A
Training Quite a Bit Somewhat A Little Not yet N/A
Research Quite a Bit Somewhat A Little Not yet N/A
Facilitating Networking Quite a Bit Somewhat A Little Not yet N/A
Initiating New Approaches and Ideas Quite a Bit Somewhat A Little Not yet N/A
Infrastructure Development Quite a Bit Somewhat A Little Not yet N/A
General Capacity Building Quite a Bit Somewhat A Little Not yet N/A
Other (Please specify)
Quite a Bit Somewhat A Little Not yet N/A
Quite a Bit Somewhat A Little Not yet N/A
Quite a Bit Somewhat A Little Not yet N/A

Ways in which you have had Contact with the Center: (check all that apply)

Website
Listserv (e.g., Monthly ENEWS, Weekly Practitioners, Policy Makers)
Received direct mail or email
Had contact at a presentation or special meetings
Center staff came to us
Indirect contact through center materials, special reports, publications, etc. (e.g., shared by a colleague)
We visited Center and/or a site with which the Center works
Other (specify)

Satisfaction with Center (check rating)

How easy was it to access the Center's resources? Not At All Somewhat Very Extremely Well
How timely and appropriate was the Center's response to your requests? Not At All Somewhat Very Extremely Well
How well did the Center meet your needs? Not At All Somewhat Very Extremely Well
Based on your experience with the Center, would you use it again and/or recommend that others make contact? Yes No

Other comments?




The Center for Mental Health in Schools is co-directed by Howard Adelman and Linda Taylor and operates under the auspices of the School Mental health Project in the Dept. of Psychology, UCLA

Support comes in part from the Office of Adolescent Health, Maternal and Child Health Bureau, Health Resources and Services Administration. Co-funding comes from the Center for Mental Health Services, Substance Abuse and Mental Health Services Administration. Both HRSA and SAMHSA are agencies of the U.S. Dept. of Health and Human Services.