OMB No.: 0970-0318
Expiration Date:  02/28/2010

6288-415

Including yourself, how many staff attended the training?

|     |  NUMBER OF STAFF

For each staff member who attended the spring 2006 IM/IL training event (including yourself), indicate the title of the staff member in the table provided below.  If the staff member has more than one title, select the title for that staff member that is associated with their highest level of management responsibility.

Staff Title	PLEASE MARK THE TITLE OF EACH STAFF MEMBER IN THE COLUMN PROVIDED
	Staff Member 1	Staff Member 2	Staff Member 3	Staff Member 4	Staff Member 5
a. Head Start Program Director
b. Child Development & Education Manager
c. Health Services Manager
d. Family & Community Partnerships Manager
e. Disability Services Manager
f. Child Development Supervisors
g. Home-Based Supervisors
h. Teacher
i. Home-Based Visitor
j. Other (Specify) _____________________
k. Other (Specify) _____________________

B3.

On a scale of 1-4, with 1 being “strongly disagree” and 4 being “strongly agree,” how would you rate the following aspects of the spring 2006 IM/IL training event you attended?

	MARK ONLY ONE IN EACH ROW
	Strongly Disagree	Disagree	Agree	Strongly Agree
a. The three IM/IL goals were clearly explained	1	2	3	4
b. The workshops presented ideas for program enhancements that addressed the goals of IM/IL	1	2	3	4
c. The instruction received at the training was adequate to train my own staff to implement IM/IL	1	2	3	4
d. Quality of the “take-home” materials (resource materials and handouts) was adequate to train my staff	1	2	3	4
e. The trainers explained how to adapt IM/IL to meet the needs of a program like ours	1	2	3	4
f. The ideas for program enhancements seemed like they would work in our program	1	2	3	4
g. The training prepared us to implement IM/IL	1	2	3	4
h. The training event provided new information and resources	1	2	3	4

Looking back on the spring 2006 IM/IL training event, how would you describe the allocation of time during the training? Rate the allocation of time during the training with 1 being “too little time,” and 5 being “too much time.”

	MARK ONLY ONE IN EACH ROW
	Too Little Time		About the Right Time		Too Much Time
a. Time for lecture and direct instruction	1	2	3	4	5
b. Time on how to engage adults in IM/IL	1	2	3	4	5
c. Time for asking questions	1	2	3	4	5
d. Time for practicing movement activities	1	2	3	4	5
e. Time for planning our implementation	1	2	3	4	5
f. Time for the topic of improving children's nutrition	1	2	3	4	5

Looking back on the spring 2006 IM/IL training event, on a scale of 1 to 5, where 1 is “poor” and 5 is “excellent,” how would you rate the overall quality of the training?

CIRCLE ONLY ONE

Did your program experience unexpected costs associated with attending the spring 2006 IM/IL training event?

What were the costs?

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At the spring 2006 IM/IL training event, was your program made aware of technical assistance that would be available when your program implemented IM/IL activities?

1		Yes
0		No

Did you leave the spring 2006 IM/IL training event with a written action plan for how your program would implement IM/IL?

1		Yes
0		No

Looking back at the spring 2006 IM/IL training event, what did your program find most useful and least useful?

__________________________________________________________________________________

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The questions in this section ask about how your program tried to implement activities discussed at the spring 2006 IM/IL training event.

Has your program tried to implement any IM/IL activities?

What are the reasons your program did not try to implement any IM/IL activities? Indicate your reasons on the list below.

MARK ALL THAT APPLY

1		We lacked the resources (either money or in-kind support) in the community to help us in our implementation
2		The training our program received at the spring 2006 IM/IL training event was not adequate preparation for us to train other frontline staff
3		The management staff did not have enough time to devote to IM/IL
4		The management staff did not have adequate skills to train our frontline staff
5		The frontline staff did not have enough time to participate in training
6		We needed more technical assistance
7		Our frontline staff members were not enthusiastic about the goals of IM/IL
8		We thought it would be difficult for our staff members to maintain interest in IM/IL
9		The parents of children in our program were not enthusiastic about the goals of IM/IL
10		IM/IL was not a priority of our program's Policy Council, Governing Board, or Health Services Advisory Committee
11		Other areas in our program were a higher priority
12		High staff turnover
13		We did not have enough space for the children to be physically active
14		The children are not at the program long enough each day
15		We felt we needed materials to implement IM/IL, but our program did not have the funds to purchase them
16		We felt we needed materials to implement IM/IL, but our program had trouble making the materials
17		Other (Specify) ___________________________________________________________________

What is the single most important reason that your program did not try to implement any IM/IL activities? Choose the number from the list above.

|__|__| NUMBER OF THE MOST IMPORTANT REASON

Of the activities your program has implemented so far, which of the three IM/IL goals are these activities intended to address?  

MARK ALL THAT APPLY

1		Increase the quantity of time spent in moderate to vigorous physical activities during the daily routine to meet national guidelines for physical activity
2		Improve the quality of structured movement experiences intentionally facilitated by teachers and adults
3		Improve healthy nutrition choices for children every day

Compared with all other services and activities your program provides in Head Start, how would you rank the importance of the following activities in your program before the spring 2006 IM/IL training event?

	MARK ONLY ONE NUMBER IN EACH ROW
	Not Important At All				Very Important
a. Moderate to vigorous physical activity	1	2	3	4	5
b. Structured movement experiences	1	2	3	4	5
c. Healthy nutrition choices	1	2	3	4	5

Compared with all other services and activities your program provides in Head Start, how would you rank the importance of the following activities in your program after the spring 2006 IM/IL training event?

	MARK ONLY ONE NUMBER IN EACH ROW
	Not Important At All				Very Important
a. Moderate to vigorous physical activity	1	2	3	4	5
b. Structured movement experiences	1	2	3	4	5
c. Healthy nutrition choices	1	2	3	4	5

Regarding the activities your program has tried to implement so far, would you say these activities:

MARK ONLY ONE

1		Place more emphasis on moderate to vigorous physical activity/structured movement experiences
2		Place more emphasis on healthy nutrition choices
3		Emphasize about equally both healthy nutrition choices and moderate to vigorous physical activity/structured movement experiences

Has your program stopped doing any of the IM/IL activities that it implemented after the spring 2006 IM/IL training event?

1		Yes
0		No

There are many challenges your program may have faced while trying to implement IM/IL activities. How would you rate the success of your program in implementing the following on a scale from 1 to 5, where 1 is "not at all successful" and 5 is "extremely successful"?

	MARK ONLY ONE NUMBER IN EACH ROW
	Not At All Successful				Extremely Successful
a. Moderate to vigorous physical activity	1	2	3	4	5
b. Structured movement experiences	1	2	3	4	5
c. Healthy nutrition choices	1	2	3	4	5
d. IM/IL overall	1	2	3	4	5

What are the reasons that might have contributed to any success that your program has had in implementing IM/IL? Indicate your reasons on the list below.  

MARK ALL THAT APPLY

1		We had the community resources (either money or in-kind support) to help us in our implementation
2		The spring 2006 IM/IL training event provided us with the necessary training to train our staff
3		We had good technical assistance
4		We had an enthusiastic and capable leader to implement these activities
5		Our staff members were enthusiastic about the goals of IM/IL
6		The parents of children in our program were enthusiastic about the goals of IM/IL
7		Obesity prevention was a priority of our program's Policy Council, Governing Board, or Health Services Advisory Committee
8		Before the spring 2006 IM/IL training event, we were already actively involved in efforts to increase children's physical activity and improve their nutrition
9		We have not been too successful, so NONE of these reasons apply GO TO C12
10		Other (Specify) ___________________________________________________________________

|__|__| NUMBER OF THE MOST IMPORTANT REASON

What challenges has your program experienced in implementing IM/IL? Indicate your reasons on the list below.

MARK ALL THAT APPLY

1		We lacked the resources (either money or in-kind support) in the community to help us in our implementation
2		The training our program received at the spring 2006 IM/IL training event was not adequate preparation for us to train other frontline staff
3		The management staff did not have enough time to devote to IM/IL
4		The management staff did not have adequate skills to train our frontline staff
5		The frontline staff did not have enough time to participate in training
6		We needed more technical assistance
7		Our frontline staff members were not enthusiastic about the goals of IM/IL
8		It was difficult for our staff members to maintain interest in IM/IL
9		The parents of children in our program were not enthusiastic about the goals of IM/IL
10		IM/IL was not a priority of our program's Policy Council, Governing Board, or Health Services Advisory Committee
11		Other areas in our program were a higher priority
12		High staff turnover
13		We did not have enough space for the children to be physically active
14		The children are not at the program long enough each day
15		We felt we needed materials to implement IM/IL, but our program did not have the funds to purchase them
16		We felt we needed materials to implement IM/IL, but our program had trouble making the materials
17		Other (Specify) ___________________________________________________________________

What is the single most important reason that your program might not have been as successful as you hoped it would be in implementing IM/IL? Choose the number from the list above.

|__|__| NUMBER OF THE MOST IMPORTANT REASON

Does your program have a written plan for implementation of IM/IL?

1		Yes
0		No

Before selecting IM/IL activities to implement, did you review your current program activities and identify areas in which you were not implementing activities like the ones presented at the spring 2006 IM/IL training event?

1		Yes
0		No

In selecting IM/IL activities to implement, what did your program target to promote healthy weight in children? 

MARK ONLY ONE

1		Mostly children's level of physical activity
2		Mostly children's nutrition choices
3		Children's level of physical activity and children's nutrition choices by about the same amount

In selecting IM/IL activities to implement, in what setting did your program expect to bring about changes in children's physical activity and eating behaviors? 

MARK ONLY ONE

1		Mostly in the Head Start setting
2		Mostly in the home setting
3		In the Head Start and home settings by about the same amount

From the list below select the specific behavior changes your program expects to achieve, based on the IM/IL enhancements being implemented.

MARK ALL THAT APPLY

1		Increase the amount of children's moderate to vigorous physical activity during the Head Start day
2		Increase the amount of children's moderate to vigorous physical activity when children are at home
3		Increase the quality of children's structured movement experiences during the Head Start day
4		Increase the quality of children's structured movement experiences when they are at home
5